Oral Answers to Questions

HEALTH

The Secretary of State was asked—

NHS Information Technology

David Jones: What recent assessment she has made of the effectiveness of the use of information technology in the NHS.

Caroline Flint: The digital technology being delivered through the national programme for IT is already being used widely by clinicians on a daily basis, and 91 per cent. of general practitioners have made a booking through choose and book. Most importantly, it is bringing benefits for patients by improving their care, safety and experience, and by improving the efficiency of services across the NHS in England.

David Jones: The Minister will be aware that the British Medical Association's working party on information technology is concerned about the non-compatibility of the IT systems of the four home countries, and in November it wrote to the director general for IT in the NHS to express that concern. Will the Minister please say why it was not thought appropriate to design compatibility into the systems from the outset, and what effect does she think that lack of compatibility will have on patient safety, particularly in border areas?

Caroline Flint: Of course we are working with our colleagues across the borders of England to set standards and to consider issues of interoperability. For example, although the devolved Administration in Wales have chosen to adopt different approaches to the development of IT in relation to the health service in Wales, we are in discussions about how we can facilitate the migration of existing NHS shared administrative services, so that the NHS care record service data spine can be used. We are working together, and I am pleased to say that across England, we can prove that we can work with the system to produce results daily. Choose and book is rapidly being taken up across the country, and we are making progress on electronic prescriptions and many other measures. I am sure that that is something that the devolved Administrations will want to consider.

Angela Eagle: Will my hon. Friend take this opportunity to congratulate the managers and staff at the Clatterbridge centre for oncology, which several years ago introduced an innovative IT scheme enabling its nine new Linux scanners, which deliver radiotherapy, to be chosen and booked by people who are expecting treatment? That ensures that there is huge productivity, and waiting lists for radiotherapy, which used to be very long, have now plummeted. People are getting their cancer treatment at the time of their choice, much faster than ever before.

Caroline Flint: Exactly. Our ambition is to provide better and safer services, quicker than ever before, and innovative clinicians are working with managers in the health service, and are co-operating with us, to do exactly that. I pay tribute to those people at her local hospital, who are making a difference to the lives of the patients whom they serve.

David Ruffley: The April Public Accounts Committee report on the national programme for IT reported that the care record service is running two years behind schedule, with no firm plans for deploying the necessary software. Clinicians do not have faith in the programme. Four years after its start, there is uncertainty about the costs for the local NHS, and one of the largest suppliers, Accenture, has bailed out. Why is it that under Labour management, the NHS appears to be in the information super lay-by, when it should be on the information super highway?

Caroline Flint: We acknowledge the PAC report, but it happens to be a year out of date, and it is based on a previous National Audit Office report—  [Interruption.] Let us just hear what the NAO has to say about our programme for improving technology in the NHS. It says that the NHS connecting for health programme
	"has adopted the highest security standards for access to patient information",
	and that
	"The Programme has the potential to generate substantial benefits for patients and the NHS."
	It also says:
	"The Department and NHS Connecting for Health have made substantial progress with the Programme."
	On the electronic patient record, it is important that we take time to get it right; that is better than speeding ahead and getting it wrong.  [Interruption.] The Tories had 18 years to get on top of the technology, and not a lot was done. The question was asked—

Mr. Speaker: Order. I call Martin Linton.

Martin Linton: Has my hon. Friend made any assessment of the switchover from X-ray to digital imaging at St. George's and other hospitals, and on the roll-out of packs in that regard?

Caroline Flint: I thank my hon. Friend for raising that important point. We are moving from old-fashioned X-ray films to digital images, which will transform the NHS. Over 170 hospitals are already using the system, and all NHS hospitals will have it by the end of the year. I congratulate St. George's hospital on its commitment to providing the best possible service. On top of all that, within the first year we expect to save £40 million.

Andrew George: Among the large number of answers that I have received from Ministers is one from 4 September last year in response to a question about what information the Department collects from primary care trusts, acute trusts and strategic health authorities on the allocation of budgets for choose and book, as well as information returned about assessment. The answer was "None". How can the Minister, in response to earlier questions, suggest that the Department is satisfied that it can make an assessment about the choose and book system if it is clearly not collecting any kind of information from people who are using the system?

Caroline Flint: We regularly collect information in different ways on the choose and book system and how it is working. I was pleased to visit a GP practice on Monday, and I talked to the GP about how it was working in that area. One thing is true: the IT to support choose and book has been delivered; the IT to support electronic prescriptions has been delivered; the broadband network has been delivered ahead of schedule; and digital X-ray machines have been fully deployed across London and the south of England. That is what is happening, and it is transforming lives. We will collect information where necessary, but we would rather provide the facility and ability for the local health service to get on with the job and produce the results.

Stephen O'Brien: The Minister says that everything has been delivered, but the blunt truth is that twice the Government have set a target for choose and book, and twice they have missed it. Last year, Lord Warner promised to resign if choose and book was not delivered this March; in December he scuttled off on a fix-up job and is now blaming GPs and MPs for his failures. David Nicholson has criticised the bunker mentality of connecting for health, and today—

Mr. Speaker: Order. The hon. Gentleman should ask a question.

Stephen O'Brien: Very quickly, I should like to ask a question. When will the Secretary of State admit that that is a missed target, come clean and deliver something that is worth while?

Caroline Flint: We are delivering connecting for health on time and on budget—but perhaps the hon. Gentleman's question was written by Professor Ross Anderson, who is an independent adviser on IT to the Select Committee on Health. Among a number of suggestions for Conservative party policy, he proposed a fresh look at IT policy, suggesting that in each civil service department there should be a chief information officer at grade 1 and that
	"the top 50 per cent. performers should expect a knighthood",
	based on their IT advice. If that is the best advice that the Opposition can obtain for operating a modern Government using the modern technology necessary for our public services, so help them.

Cost Shunting

Robert Key: What recent assessment she has made of the extent of cost shunting between NHS hospitals and local authorities.

Ivan Lewis: Delivering high-quality social care and health care in every area while securing maximum value for money can be achieved only by NHS bodies and local authorities working together to make the best use of the available resources. We have made it very clear that cost shunting is not acceptable.

Robert Key: Can the Minister confirm that 17 per cent. of NHS capital resources are locked up in that problem? Does he agree that it does not matter whether we rebrand bed blocking as delayed discharge or cost shunting, because we are dealing with some of the most vulnerable people in our community, many of whom suffer from dementia? It is not just embarrassing, it is shameful that no Government Department is prepared to get a grip on the problem, whether it is the Department for Communities and Local Government funding local authorities, or the Department that runs the health service. We cannot go on with wards full of people who should not be in hospital and need not be there, because it is all down to accountancy.

Ivan Lewis: Some very specific things have been done to bring local authorities and the NHS together at the local level. Local area agreements bind them together through shared objectives and targets, joint appointments are increasingly made between the health service and local government at local level, and the Local Government and Public Involvement in Health Bill requires a duty of partnership for the first time from local government, primary care trusts and other health bodies. I have to say to the hon. Gentleman that Members on both sides of the House remember when winter crises were an annual event under the Conservatives, so we will not take any lectures on bed blocking from him.

Joan Humble: Does my hon. Friend agree that one issue for social services has arisen because of the success of the NHS in dealing with more patients and discharging more patients? With that increased throughput, many such patients have more intense needs, so will my hon. Friend look at developing more intermediate care schemes in which health and social care departments can work to discharge people into the community, but with more support so that they can go back into their own homes?

Ivan Lewis: My hon. Friend is absolutely right. That is at the heart of the debate about re-engineering services away from the acute end of the national health service into community-based health services and social care. That leads to more investment in early intervention and preventive services, and it increasingly gives people what older people and their families tell us they want—care so that individuals can be supported to continue living at home for as long as possible. It is shameful that the Opposition automatically present all those changes as cuts, not as changing services to meet people's needs.

Julia Goldsworthy: To what extent will greater co-operation and accountability be introduced by pooling budgets? Is the Minister aware of Cornwall county council's local government review submission, which proposes exactly that? Are any discussions taking place at a cross-departmental level to encourage that?

Ivan Lewis: I have a great deal of sympathy with what the hon. Lady says. We need to move from a notion of partnership between local government, the NHS and the voluntary sector to a notion of integration in every local community. We must move away from health care and social care being provided separately, so that local government and the health service locally truly secure the health and well-being of the local population, strongly focused on the needs of individuals, older people, disabled people and their carers, and families.

David Taylor: Is there not some risk that the discussion will develop into blame shunting, as David Stout, the newly appointed director of the PCT Network, has suggested? Local people do not know who runs what, and if organisations blame each other, public confidence in both sectors will deteriorate. How can we restore the momentum towards co-operation between social services and the NHS that my right hon. Friend the Member for Holborn and St. Pancras (Frank Dobson) set in train all those years ago?

Ivan Lewis: I agree entirely with my hon. Friend. We must break down the Berlin wall between the NHS at local level and local government. No longer is the prize simply the integration of health care and social care. The full range of services that local government provides make a difference to the quality of life of older people, disabled people and vulnerable people. Local area agreements, a statutory duty of partnership, guidance on how services should be commissioned in an integrated way—all these matter, but so does the culture at local level. We expect leaders in the NHS and local government to provide leadership. We expect professionals to put aside their professional prejudices, organisational boundaries and historic enmities and focus on the needs of the people who require services.

Acute Hospital Services

Michael Gove: If she will make a statement on the future of acute hospital services.

Patricia Hewitt: The future of acute hospital services increasingly lies in high-quality, independently regulated and locally accountable NHS foundation trusts, such as Frimley Park in the hon. Gentleman's constituency.

Michael Gove: The Minister is aware that accident and emergency units in hospitals that serve my constituents are threatened with closure. What she may not know is that the so-called clinical evidence base justifying these cuts on medical grounds has been drawn up by someone who is not even a doctor, and the officials executing the cuts refuse to make improving clinical outcomes one of the aims of their work. Is it not clear that the cuts have nothing to do with helping people in pain and everything to do with ministerial mismanagement?

Patricia Hewitt: The hon. Gentleman is talking absolute nonsense. Hospitals are changing because medicine is changing, and there are discussions going on in Surrey and other parts of the country about how to improve services—in some cases by giving more treatment closer to patients' homes in health centres, community hospitals or GP surgeries, but also about how to ensure, for instance, that for people who have suffered a heart attack or stroke, specialist life-saving care is available in specialist centres. That will not be the case in every single local hospital—but no formal proposals have been made yet on service improvements and changes in Surrey. They will be made in due course, and consultation on them will not start until the summer. That is the appropriate time to have a debate about how services in Surrey can be improved to give people better care and a better chance of having their lives saved.

Keith Vaz: The Secretary of State knows that there has been a promise of new money for Leicester—£700 million for the pathway project. Although there will be a delay in the application for foundation status, will she reiterate the Government's full support for the rebuilding of the hospitals that was promised under pathway, including refurbishment of the Leicester general hospital, so that in Leicester we can provide the best possible care in the best hospitals in the country?

Patricia Hewitt: My right hon. Friend and I have taken a close interest in this matter over several years, and I am delighted to say that last year the Minister of State, my hon. Friend the Member for Leigh (Andy Burnham), who has responsibility for reform and delivery, announced a private finance initiative rebuild across the three hospitals of the University Hospitals of Leicester NHS Trust. My understanding is that, following some discussions with the private sector partner about the cost, a review is taking place, but I have no doubt that that investment will continue for the benefit of people not just in Leicester but across Leicestershire and other parts of the east midlands.

Richard Taylor: Does the Secretary of State agree with the Department of Health document "Keeping the NHS local: a new direction of travel", which in referring to smaller acute general hospital reconfigurations states:
	"The objective is to provide at a minimum a 'first port of call'...a service able to receive and provide assessment, initial treatment and transfer where necessary"?

Patricia Hewitt: As the hon. Gentleman knows, we have recently published a series of reports from the clinical directors—the tsars—on, for instance, accident and emergency medicine, heart attacks and stroke. He will also be aware that, because of the rapid changes taking place in medicine, we now have an opportunity to ensure that some of those assessment and diagnostic services to which he refers can be provided even more conveniently than in a local district hospital—for example, in a walk-in centre, a GP centre or an urgent care centre—but also that some of the more specialist services need to be provided in specialist centres with enough patients to ensure that the doctors and other staff there can provide the best possible care. However, as I recently saw at Harrogate district hospital—one of the two best hospitals in the country, according to the Healthcare Commission—it is very possible for a small hospital that has made itself the focal point for a wider network of care to provide outstanding services to patients within its community.

David Winnick: My right hon. Friend's visit to the Manor hospital in Walsall was very welcome. Apart from the reduction in waiting times, was she shown the extensive building plans, the largest development of the hospital since it was built in the 19th century, which was the subject of an Adjournment debate of mine last June to which the Under-Secretary of State for Health, my hon. Friend the Member for Bury, South (Mr. Lewis) replied? As I say, I am pleased that she did visit.

Patricia Hewitt: My hon. Friend has been rock solid in his support for Manor hospital and the trust, and the substantial investment programme for the new hospital, which is so badly needed on the Manor hospital site. I congratulate the staff at Manor hospital and the local primary care trust. It will be one of the first hospitals in the country to ensure that for almost every patient with almost every condition there will be a maximum of 18 weeks—and far less than that, for many of them—between GP referral and hospital operation by the end of this year, one year earlier than we pledged in our manifesto. That kind of excellent, fast, safe care was never delivered in hospitals around the country under the Conservative party. It is now being delivered, thanks to the investment and reforms that we are making.

Humfrey Malins: The Secretary of State will be aware that in Surrey the accident and emergency provision at St. Peter's hospital and at the Royal Surrey county hospital are under threat. My hon. Friends take the view, as I do, that this will be deeply damaging. Is the Secretary of State worried that although the proposals have been floated since last year, the promised consultation document did not come out at Christmas, in January or in March, as we were led to believe, and is now promised for some time in June? Can the right hon. Lady guarantee that this suspense for the people of Surrey will not be dragged out much longer? It is a great burden for them at present.

Patricia Hewitt: I understand the uncertainty that is inevitably caused when the local NHS considers how best to improve services. As I have just said to the hon. Member for Surrey Heath (Michael Gove), there will be a consultation on specific proposals in relation to hospital and other services in Surrey, and the commitment is that that will start in the summer. The important thing is to ensure that the proposals are right and clinically based, and now that the NHS is back in balance and the NHS in the hon. Gentleman's part of the country has made such enormous progress in getting on top of the financial problems that have arisen, I hope that he and his constituents will accept that the changes proposed will be driven by the need to improve clinical outcomes for patients, not the need to balance the books.

Sharon Hodgson: Will my right hon. Friend join me in welcoming the action taken by my local hospital, the Queen Elizabeth hospital in Gateshead, which is another of the 13 early adopter sites? That will ensure that the 18-week target is hit by this December—one year early, as she said in reply to my hon. Friend the Member for Walsall, North (Mr. Winnick).

Patricia Hewitt: I am grateful to my hon. Friend for giving me the opportunity to thank and congratulate the staff at that Gateshead hospital and others. Eighteen hospitals will expect to achieve that 18-week target one year ahead of time by the end of this year. Staff at Gateshead, Walsall and other hospitals are reorganising services. For instance, in the case of orthopaedic patients at Walsall, the staff found that it was taking 200 hours of staff time, much of it administrative, to take a patient from initial receipt of the GP referral through to the hip replacement or other operation. By reorganising the way in which they worked—not by putting in more money—they reduced that to just 30 hours, enabling them to transform the lives of between six and seven people in the time they had previously taken to treat just one. That is the kind of improvement that we are seeing, thanks to NHS staff.

Andrew Lansley: Is the Secretary of State aware of a document called "Squaring the Triangle", which is intended to be the basis for the reconfiguration of acute hospital services in west Surrey? It says:
	"Current Department of Health and Strategic Health Authority guidance suggests that to be viable, a full A&E Department in the future would need to be supported by a catchment population of between 450,000 and 500,000 people. On this basis only two full A&E Departments (rather than the existing three) will be viable for the West Surrey population in the future."
	Is the Secretary of State aware of that? Does she endorse or reject that reference to Department of Health guidance?

Patricia Hewitt: As I have said, there are as yet no settled proposals for service improvements in west Surrey—or, indeed, in east Surrey. As the hon. Gentleman will be aware from Professor Sir George Alberti's recent report on emergency medicine, there is already a very wide range of different kinds of A and E departments, from those providing the full range of trauma centres down to those providing— [ Interruption . ]

Mr. Speaker: Order. The hon. Member for Surrey Heath (Michael Gove) must be quiet. A question has been asked and it is courteous to listen.

Patricia Hewitt: Thank you, Mr. Speaker.
	There is already a very wide range of services provided by different A and E departments. I hope that the hon. Member for South Cambridgeshire (Mr. Lansley) would be as focused as we are on ensuring that A and E services give the best possible care to every patient, whether they need it locally, much closer to home, or in a specialist centre, possibly slightly further away, in order to save their lives.

Andrew Lansley: The Secretary of State is not answering the question. I am focusing on both specialisation and access, and quality of services includes the issue of access. Will she answer the question? Does she endorse or reject the reference to Department of Health guidance? If this is acted on in west Surrey, the implication is that an A and E department will shut. If it were to be acted upon in the north-west of England, where there is one type 1 A and E department to every 207,000 people, half the A and E departments in that region would have to shut. Why do not we not see that happening in the north-west of England, when my colleagues in Surrey see their A and E departments threatened, apparently on the basis of Department of Health guidance?

Patricia Hewitt: I think that we can all see the next Conservative party campaign coming, with the misleading propaganda that we have come to expect from it on health. The hon. Gentleman completely misses the point that different A and E departments will offer different sorts of services. For the most specialist services, including stroke services, about which I know he has a long-standing concern, a larger population is required to ensure that specialist staff are available 24 hours a day, seven days a week to deal with the patients who need that care. Different A and E departments will provide a different range of services. That will be one of the key themes of the guidelines and proposals on urgent and emergency care that the Department will publish shortly.

CATS Services (Chorley)

Lindsay Hoyle: If she will make a statement on clinical assessment, treatment and support services in Chorley.

Ivan Lewis: I suspect that this answer is a direct response to my hon. Friend's persistence on the matter, Mr. Speaker. Central Lancashire primary care trust has agreed with Lancashire Teaching Hospitals NHS Foundation Trust that CATS services will be provided at the trust's hospitals, including Chorley and South Ribble hospital.

Lindsay Hoyle: I thank the Minister for reaffirming the position. He could possibly go as far as congratulating the primary care trust on listening to the people of Chorley, because the decision is ground-breaking. It ensures not only that no private company will operate CATS in Chorley but that the services will be run and funded by the NHS and based at the local hospital. That is good news for Chorley. Does my hon. Friend agree?

Ivan Lewis: I congratulate my hon. Friend on the points that he has been making for some time about this issue. The consequence of the PCT's decision is that patients in my hon. Friend's constituency and in neighbouring constituencies will get the choice that they deserve, and any unacceptable waiting times for particular treatments will be slashed. In many areas, that requires a contribution from the independent sector. However, the PCT in Chorley has shown that where the NHS believes that it can do the job and achieve the outcome, it is chosen as a suitable provider. Most importantly, waiting lists and times in my hon. Friend's constituency will be reduced.

Gordon Prentice: The first wave of independent sector treatment centres was paid 11 per cent. more than NHS organisations for carrying out exactly the same operations. What is the uplift? How much more will private sector, not NHS, CATS be paid for carrying out precisely the same operations in future?

Ivan Lewis: In the context of the first wave and incentives, the issue was creating a position whereby we could ensure that, in communities where waiting lists and times were unacceptable—and should be unacceptable to the NHS—the independent sector could build its capacity and help the NHS treat those patients as quickly as possible. Whatever debate there may be about the specific amount of the incentive, that was why it was required at that stage in the process.

Community Hospitals and Services

Dawn Butler: How much her Department plans to spend on community hospitals and services in 2007-08.

Andy Burnham: We are committed to community hospitals when they represent the best solutions for local communities. To support that, we have set up a five-year £750 million programme to promote the development of community hospitals and services. To date, we have allocated around £100 million to 14 different schemes. Decisions are outstanding on a further 18 schemes.

Dawn Butler: Bringing community care and health care closer to individuals will have a profound effect on their lives, ensuring that people live longer and healthier lives. The PCTs have a vital role to play in that. Will my hon. Friend join me in condemning the Lib-Dem council in Brent—also known as the Fib-Dem council—

Mr. Speaker: Order. The Minister will not do that. Perhaps he will answer the first part of the question.

Andy Burnham: It is tempting to do as my hon. Friend asks, and I would like to, Mr. Speaker. However, perhaps I shall simply say that I agree with her that patients support the move to provide more and extended services in the heart of communities, including those in London. That comes through time and again in all the consultations that the Department has carried out.

Richard Younger-Ross: Does the Minister agree that minor injury units are an essential part of community hospitals but that the services provided are often cut, as are the hours of opening? Will he ensure that community hospitals are adequately funded to ensure a consistency of service for minor injury units and look into standardising those services in order to ensure that when people go to such units, they know what services they are going to get?

Andy Burnham: The hon. Gentleman makes an important point. Minor injury units are an important part of the 10 community hospital schemes that I announced recently. I agree that PCTs should take a view locally on where those schemes can help to fill an identifiable need. That is precisely the sort of scheme that we want. In looking further at the range of schemes recently approved, I found that many are very innovative and are offering new kinds of services to communities that have often had poor to patchy general practice in the past. It is all about bringing better and extended services to communities that have not benefited from such services in the past.

Kevin Barron: May I thank my hon. Friend for his recent announcement about the building of a new primary care centre in Rotherham? Does he accept that that will not only provide patient services seven days a week, but will have further benefits to services in the acute sector? Does he also agree that those reconfigured services in the NHS are improving the level of service to patients and should be welcomed by everyone and not cried against by Opposition Members every time we attempt to improve patient services?

Andy Burnham: The points that my right hon. Friend makes about the links between pressure on accident and emergency departments and acute hospitals generally are extremely well made. The scheme that we recently put forward and approved in his constituency includes a walk-in centre and a minor injuries unit. It also includes access to diagnostic facilities, dietary services, physiotherapy and audiology, so it truly provides a step forward for my right hon. Friend's community. He is absolutely right that the beauty and benefit of those schemes is that they can take the pressure off local acute hospitals and give patients another option rather than trekking into accident and emergency as the only available option for treatment.

Mental Health Patients (Children)

Desmond Swayne: What measures she is taking to ensure that children are not accommodated with adult mental patients.

Rosie Winterton: We have made a commitment to eliminate within two years the use of adult psychiatric wards for children younger than 16. My officials are writing to strategic health authorities informing them that if a child younger than 16 is placed on an adult psychiatric ward, it should be reported directly to the Department so that we can take appropriate action.

Desmond Swayne: Given that the Government's own commissioner, Professor Sir Al Aynsley-Green, has said that children who go into adult wards for treatment come out in a worse state than when they went in, will she guarantee that the current provisions in the Mental Health Bill that require age-appropriate treatment settings will remain unamended?

Rosie Winterton: No, I will not. One of the problems with the House of Lords amendments to the Mental Health Bill is that, in certain circumstances, they restrict the ability of clinicians to treat 16 or 17-year-olds, for example, who might be better placed on an adult ward. That imposes quite a straitjacket in terms of the clinician's ability to place people. There is also the issue of emergency treatment and the Lords amendments create further problems in that respect. However, as I said, we are certainly committed to ensuring within two years that children younger than 16 are not treated on adult wards.

Doug Naysmith: As my right hon. Friend is aware, during recent consideration of the Lords amendments to the Mental Health Bill, a number of interesting suggestions and proposals were made. Will she give me a guarantee that she will consider them very carefully?

Rosie Winterton: My hon. Friend is right to say that this is an extremely important issue. I know that he is concerned about it, and he has raised the matter with me separately. As I have said, the problem with the House of Lords amendments is that they would create a clinical and legal straitjacket, but that is not to say that important issues have not been raised, and I am sure that we shall discuss them in Committee.

James Gray: My constituent, Miss Fiona Gale of Sherston, having been treated in an adult mental health care ward and abused in various ways while she was there, was then discharged against her wishes. Tragically, she committed suicide in front of a train in my constituency shortly afterwards. The coroner agreed that she should have been treated in a separate children's ward and that there should have been a halfway house between the completion of her treatment and her discharge into the community. I welcome what the Minister has said about under-16s; will she also consider what I have said about the provision of a halfway house?

Rosie Winterton: It is absolutely tragic to hear about such cases. The hon. Gentleman mentioned that the child had been discharged against her will, and that obviously should not happen if a child is still in need of psychiatric help. The hon. Gentleman will be aware of changes made to the Mental Health Bill in the House of Lords that we are seeking to overturn, but one of the provisions that we are seeking to introduce is supervised community treatment. That would enable someone to be discharged but to remain under the care of health care professionals.

Charlotte Atkins: What evidence is there that primary care trusts and mental health trusts are discharging their duty of care to the under-18s who need mental health treatment? What proportion of under-18s have access to early intervention provision, which has proved highly successful in treating psychosis among people of that young age group?

Rosie Winterton: I cannot give my hon. Friend the exact number of children using the early intervention teams, but the spending on child and adolescent mental health services—CAMHS—increased from £284 million in 2002 to £530 million in 2005. With that increased investment, we have managed to employ more staff. There were about 7,700 in 2003; that figure went up to 9,800 in 2005. The case load has also risen by about 40 per cent. between 2002 and 2005, however. The extra investment is making a difference, but we certainly accept that there is some way to go, particularly in the development of CAMHS services, and the Under-Secretary of State for Health, my hon. Friend the Member for Bury, South (Mr. Lewis), is continuing to work on further improving those services and, in some instances, integrating them more effectively with the other services.

Tim Loughton: Yesterday in Committee Room 16, in front of MPs and Members of the Lords, two teenage girls, Lois and Antonia, gave harrowing accounts of their experiences in acute mental wards. Those were adult, often mixed-sex, wards, which contained people who had committed homicides, in which the girls were subjected to sexual abuse and invasion of privacy, and received little or no age-appropriate treatment from inappropriately qualified staff and no help with their education. On behalf of the hundreds of children placed in those wards—the number is growing—they begged for the age-appropriate amendments to the Mental Health Bill to be retained. They do not think that the Lords amendments would prove to be a straitjacket, because they would provide for age-appropriate treatment and allow for emergency admission. Why are they wrong?

Rosie Winterton: They are wrong because— [Interruption.] I am not saying that those girls are not well intentioned, or that we do not want to ensure that the situation improves. At the moment, the number of such bed days—that is, the number of days when a bed in an adult ward is occupied by under-16s and 16 to 17-year-olds—is dropping. We need to ensure that we have more accurate information about that.
	The Lords amendments include the proposal that a child should be seen by a specialist practitioner—in this instance, a CAMHS specialist. If they were on an adult ward, that would be difficult to achieve. In that sense, the problem is a real one because the CAMHS specialist would not be assigned to an adult ward. Were it more appropriate for the care of an individual aged 17 to 18 to place them on an adult ward, they would not have access to the specialist. As I have said, however, there are certain problems with the Lords amendments—

Mr. Speaker: Order. With respect to the Minister, other Members must be allowed to speak.

Nurses' Pay

Neil Turner: What the pay level of a newly qualified student nurse would be if their pay had risen in line with average earnings since 1997.

Patricia Hewitt: Basic pay for a newly qualified nurse has increased from £12,385 in 1997 to £19,645 by November this year.

Neil Turner: I thank my right hon. Friend for putting into context the large and fully justified pay increases for student nurses since 1997. New nurses need to know, however, that they have an adequate career path once they enter the service. Will she indicate what "Agenda for Change" means for nurses throughout their careers?

Patricia Hewitt: My hon. Friend makes an extremely important point. One of the most important reforms introduced by "Agenda for Change" was to open up new opportunities for nurses to build their skills and take on new responsibilities. Under the old Whitley scale, a clinical nurse specialist grade 1 could hope to achieve a salary of £26,000—barely twice that of a newly qualified nurse. Under the new system of "Agenda for Change", by November this year a nurse consultant at the highest level will be able to earn more than £90,600, which is a measure of the change and improvement that we have been able to make.

Andrew MacKay: Is the Secretary of State comfortable with the fact that, because of the actions of the Chancellor of the Exchequer, nurses in England are experiencing a staged pay increase, while those in Scotland are having a full pay increase?

Patricia Hewitt: I understand the concerns of nurses and other health service staff about the staging of the pay award. When we accepted the independent pay review body recommendations across the public sector, not simply those for the NHS, we decided to stage the implementation for this year as we took account of the wider economic position on inflation and interest rates. That is not only fair to nurses and other public sector staff, but right for the public as a whole.

Norman Lamb: I acknowledge the increases in pay over the years, which were clearly needed. Nurses are still, however, one of the lowest- paid groups of professionals in public service. Does the Secretary of State accept that nurses this year are getting a real-terms cut in pay, and that the impact on morale of the phased increase, combined with the fact that many newly qualified nurses have no job at all, is really damaging the profession? Is she proud of that situation as we approach the 10th anniversary of the Labour Government?

Patricia Hewitt: I have just explained, as I have on many occasions, why it was necessary to take account of the wider economic circumstances. It would not be in the interests of newly qualified nurses or anybody else were we to see inflation and interest rates return to the levels that they reached under the Conservative Government. We will not take risks with the economic stability and strength that have been achieved, particularly as a result of the policies of my right hon. Friend the Chancellor. The hon. Gentleman mentioned newly qualified nurses and their difficulties in getting jobs. We are making great efforts to ensure that the NHS in each region finds appropriate posts for newly qualified NHS staff to address that precise issue.

John Baron: Not only are nurses receiving a real-terms cut but the Department of Health originally argued for a pay rise of only 1.5 per cent. Given that the independent review body for nursing not only rejected the Government's figures but criticised the Department of Health for failing to provide any evidence as to how its estimate was reached, does the Secretary of State understand how angry and cheated nurses up and down the country feel when the Government seem to be plucking figures out of thin air in order to keep salaries low?

Patricia Hewitt: Salaries for nurses and other NHS staff are a great deal higher than they were under the Conservative Government, and a great deal higher than they would have been under the Conservative party's new policy of cutting public spending to make way for tax cuts.
	I remind the hon. Gentleman that there are over 80,000 more nurses in the NHS now than there were when we were elected 10 years ago. Not only has their pay increased substantially and not only will it continue to rise substantially this year as a result of the increments under "Agenda for Change", but nurses are increasingly enjoying more flexible working conditions and support for child care needs—and, of course, much better holidays, maternity and paternity leave and pay than they ever enjoyed under the hon. Gentleman's party.

Asylum Seekers

Anthony Steen: What health care provision her Department makes available to victims of human trafficking who have applied for asylum.

Caroline Flint: Asylum seekers, including those who have been victims of human trafficking, are entitled to free NHS treatment for as long as their applications, including any appeals, are being actively considered by the Home Office. Any ongoing treatment will continue free of charge for unsuccessful applicants until their removal from the United Kingdom.

Anthony Steen: Trafficked women inevitably display mental as well as physical damage. Can the Minister guarantee that all victims who have applied for asylum will receive mental health support, some kind of counselling, and psychological care—not just to help them gain security and confidence as required by article 12 of the Council of Europe convention on action against trafficking in human beings, which the Government signed only last month, but to help the criminal authorities pursue traffickers?

Caroline Flint: I pay tribute to the work done by the hon. Gentleman as chair of the all-party parliamentary group on trafficking of women and children..
	People who have been trafficked and who claim asylum can gain access to mental health services, but the Department, along with colleagues in the Home Office, intends to review access to health services for foreign nationals. We hope to report in October this year. As the hon. Gentleman will know, as part of the action plan to which the Government are committed and following the signing of the convention, we are examining ways of preventing trafficking and identifying its victims, as well as considering what services are needed. The POPPY project, which we have funded, now has funds to provide an outreach service, which will be very important to the many agencies that will play a role in supporting the needs primarily of women, and in some cases of children.

Ann Cryer: I am delighted by my hon. Friend's reply. It is comforting to know that trafficked women will be given that level of care, but what provision will there be for people who are in the country on visitors' visas?

Caroline Flint: I thank my hon. Friend, who I know takes a huge interest in this issue. I should make clear that my original answer related to those who have been trafficked and are claiming asylum. As for my hon. Friend's question about visitors' visas, emergency treatment is available to those who present themselves provided that it has priority over establishment of their status or ability to pay. That underpins the way in which we run our health service.
	There are issues involving people who should be paying and the reclaiming of funds. I understand that the Minister of State, my right hon. Friend the Member for Doncaster, Central (Ms Winterton) and colleagues across Government are examining a range of issues relating to health service access for foreign nationals, which may include insurance issues.

Maternity Services

Sadiq Khan: If she will make a statement on the future of maternity services in England.

Patricia Hewitt: On 3 April we published "Maternity Matters", which sets out how we propose to deliver on our commitment to improve maternity services for women. By the end of 2009, for the first time, mothers-to-be will have a guarantee that the NHS will give them real choice. That will include the opportunity to be supported during births, either at home or in midwifery units, by midwives whom they know and trust to care for them.

Sadiq Khan: St George's hospital in Tooting has an excellent maternity department. Both my children were born there. This summer, the hospital will open a new midwifery-led unit for low-risk women. Does my right hon. Friend agree that such units, which help to create a home away from home for women and their families, should be offered to all who wish to have their babies delivered naturally?

Patricia Hewitt: I strongly agree. That kind of midwife-led unit, which can provide superb support for women and their partners and babies, is exactly the kind of development that we want to see repeated in other parts of the country. I congratulate midwives and other staff at St. George's on that excellent development. The fact that there are 60 more midwives at St. George's than there were 10 years ago is in part what has helped make that improvement possible.

Greg Mulholland: On 17 March we heard the devastating news that the proposed new children's and maternity hospital in Leeds would not go ahead, despite having been approved by the then Secretary of State for Health in July 2004. Why has the project been pulled despite leading local specialists having said on 27 March that current services are "not fit for purpose" and that they are anxious about the continuing safety of children in hospital? When will the people of Leeds get the children's and maternity hospital that they so badly need?

Patricia Hewitt: There is no doubt that the people of Leeds need a new children's hospital and improved services; that has been recognised for a long time. Following the recent concerns and the possible delay in respect of that new hospital, the Minister of State, my hon. Friend the Member for Leigh (Andy Burnham), recently met the strategic health authority and colleagues from the trust to discuss that and to ensure that issues, particularly to do with cost, can be looked at so that the scheme can get back on track.

Jeremy Hunt: Will the Secretary of State congratulate my sister-in-law, who happens to be a constituent, on the recent birth of her son, Thomas, at the Royal Surrey county hospital, and does the Secretary of State share my hope that my constituents continue to benefit from its excellent maternity unit for many years to come?

John Bercow: My son was born there, too.

Patricia Hewitt: I am happy to congratulate everybody whose children have recently been born at that hospital, or anywhere else—perhaps I can cover all congratulations at this point. As we discussed earlier, proposals will come forward for improvements and changes in services in various parts of the country, and there will be proper and full consultation on those proposals. It is important to ensure that in the constituency of the hon. Member for South-West Surrey (Mr. Hunt) and everywhere else women and their partners have the proper choice of having a baby at home if that is what they want and it is safe, having a baby at a midwife-led unit, or having a baby in a hospital, where there would be a consultant-led unit as well as a midwifery team. We will guarantee that choice.

NHS Finances

Daniel Kawczynski: If she will make a statement on NHS financial performance in the year 2006-07.

Andy Burnham: On the basis of results reported at quarter three, we believe that the NHS is on course to deliver at least a balanced financial position at the end of the 2006-07 and continues to perform well against key service targets.

Daniel Kawczynski: I thank the Minister for that reply. He might be aware that the  Health Service Journal recently published some very out-of-date and inaccurate information about the financial aspects of various trusts, one of which was the Shrewsbury and Telford Hospitals NHS Trust. Please will he issue the latest figures so that publications such as the  Health Service Journal have up-to-date figures? Also, does he agree that Tom Taylor, the chief executive of the Royal Shrewsbury hospital, is doing a great job of turning around the finances of our hospital?

Andy Burnham: I agree that the chief executive is doing an outstanding job. The hon. Gentleman might be aware that the latest figures at quarter three show that the trust was forecasting a £2.3 million deficit for year-end, but I can update that by telling him that the view of the strategic health authority is that the trust continues to make improvements and the expectation is that it will continue to improve in this financial year. The expected improvements relate to both the application of resource-accounting and budgeting and the effect of the national payment by results policy. Therefore, there is good news. The hon. Gentleman is right that his trust is on an improving course, and I hope that we can look forward to having his support in continuing to help it get into financial balance.

Andrew Miller: Will my hon. Friend the Minister congratulate my primary care trust on getting its books back into balance and, pursuant to his response earlier on community hospitals, will he ensure that the next round of investment takes into account fabulous community institutions such as Ellesmere Port hospital, which are especially fabulous for patients such as stroke victims?

Andy Burnham: I certainly pay tribute to my hon. Friend's primary care trust and to others around the country, which have done an outstanding job in difficult circumstances in getting the NHS into a position whereby we can predict that overall, it will balance its books this year. It is because we have asked the NHS to take some of those difficult decisions and to tackle overspending that PCTs such as my hon. Friend's can support the excellent community services that he rightly draws attention to. It has been a difficult year for many PCTs, but we can now look forward to a year in which we can bring down waiting lists and improve the range of services for patients.

Dentistry

Greg Hands: What assessment she has made of access to NHS dentistry services in (a) 2005-06 and (b) the 2007-08 financial year.

Rosie Winterton: In April 2006, primary care trusts had commissioned 75 million annual units of dental activity; by January 2007 that had risen to 78.4 million.

Greg Hands: The chief dental officer leaked to the press on Friday that instruments used to perform root canal treatments will now have to be disposable. The excellent NHS dentist on North End road is concerned about access, pointing out that those regulations could cost £35 per root canal treatment, which is half the total that a PCT typically spends on a whole course of treatment. Given those new regulations and the fact that no extra funding is being provided, is not the Minister's purpose to create an NHS dentistry system that is solely about tooth extraction?

Rosie Winterton: First, I challenge the hon. Gentleman's assertion that this information was leaked; it was sent to all dentists, and there was a ministerial statement about it. Moreover, and as he knows, this was a safety issue relating to Creutzfeldt-Jakob disease. Dentists with a good NHS commitment are given some £80,000 towards their business expenses and are expected within that to offer proper equipment and treatment and proper staff to carry that treatment out. So such expenses are perfectly well covered by the existing amount given to dentists to help run their businesses.

Point of Order

Tim Loughton: On a point of order, Mr. Speaker. I seek your guidance on correcting the record regarding a reference to me made by the hon. Member for Rhondda (Chris Bryant) during business questions last Thursday.

Mr. Speaker: It is not the purpose of the points of order system to correct the record. If the hon. Gentleman had read  Hansard, he would have noted that I stopped the hon. Member for Rhondda (Chris Bryant) in his tracks, to put it mildly.

Chris Bryant: I still ran the marathon.

Mr. Speaker: The hon. Gentleman was stopped because he had no right to criticise any hon. Member who had not been notified of such criticism in advance. I said at a later stage that the matter was finished with, and I hope that the hon. Member for East Worthing and Shoreham (Tim Loughton) will leave it at that.

Carers (Identification and Support)

Barbara Keeley: I beg to move,
	That leave be given to bring in a Bill to require health bodies to identify patients who are carers or who have a carer; to require identified carers to be referred to sources of help and support and to make further provision in relation to such arrangements; to make provision in relation to the responsibilities of local authorities and schools for the needs of young carers and their families; and for connected purposes.
	In March 2006, I introduced a Bill with the same aims as the first part of this new one. As I told the House then, 1 million carers in the UK care for more than 50 hours per week. The 2001 census figures show that carers are twice as likely to suffer ill health if they care for 50 or more hours a week. Medical research also suggests increased ill health among those caring for a person suffering from dementia or stroke disease. It is my view that we must intervene to identify and support the most hard-pressed carers, who care for more hours than the hours of any full-time job.
	In my Worsley constituency, the highest level of caring commitment is needed in the two wards with the highest levels of people with stroke and heart disease, and with cancer. While the national average is one in five carers caring for more than 50 hours a week, that rises to one in four in Walkden North ward in my constituency, and to one in three in Little Hulton ward.
	Those carers play a vital role in health and social care. They are key partners in care for the NHS, but their own health is also threatened and there is a need for recognition of carers' health needs. In 1999, the Government gave GPs and primary health care teams a five-point checklist for use with carers in their practice population. The first requirement in the list was that GPs should identify those patients who are carers or who have a carer. Eight years on from the launch of that national strategy, research shows that the work done nationwide by GPs and primary care teams to identify carers in their practice population is still inconsistent. Research by the Princess Royal Trust for Carers concludes that only a small proportion of the total number of carers is being identified. Even GP practices with good links to their local carers' organisations are not doing the work necessary to identify all those carers whose health might be affected by their caring responsibilities.
	Two carers known to Carers UK provide examples of how important it is to identify carers. Valerie Low of Carlisle cares for her husband, who was severely brain- damaged in a car accident in 1997. For years, Mrs. Low did not know that advice or respite care were available to help her as a carer. Now that she has been identified, she arranges respite care from Crossroads.
	Tracy Barker from the Isle of Wight has cared for her son for 16 years. He has autism, asthma and epilepsy. Like many parent carers, Ms Barker did not see herself as a carer and had no idea of the support available to help her. She struggled to pay bills, yet she had not been told about carer's allowance. Eventually, she had to move to a different area for financial reasons, and then she suffered depression. Now that she has been identified as a carer, she receives carer's allowance and has attended a number of courses that have helped her.
	If they are not identified, carers will struggle without the help or support that they need. My Bill would require that primary care trusts and local health boards ensure that effective procedures exist within primary care to identify carers, and that carers are referred for advice and given regular health checks.
	The Pensions Bill also requires the identification of those carers caring for 20 or more hours per week so that they can earn the carer's contribution credit. My hon. Friend the Minister for Pensions Reform has made a commitment to use the Government's review and update of the national carers strategy as an opportunity to explore how that identification can be carried out by health and social care professionals. That is a welcome step forward.
	In previous years, hon. Members of all parties have given their support to carers week, which this year runs from 11 to 17 June. Its main objective is to enable new and "hidden" carers to access support and services.
	Young carers are perhaps the most hidden of all carers. The 2001 census records some 175,000 young carers, but only 30,000 of them are known to young carers support services such as the Princess Royal Trust for Carers and other children's charities. Indeed, a survey by NCH and Carers UK showed that fewer than one in five of known young carers have received an assessment of any kind.
	The Princess Royal Trust for Carers believes that it is likely that the most vulnerable young carers, including some of the 13,000 who care for more than 50 hours a week, continue their caring role throughout their childhood without any support. Young carers may have parents with substance misuse or alcohol problems, and the extent of that problem is not fully understood. The "Hidden Harm" report estimated that 250,000 to 350,000 children have parents with serious substance misuse problems. The alcohol harm reduction strategy for England states that between 800,000 and 1.3 million children are affected by parental alcohol problems. In the families of alcoholics or problem drug users, children may find themselves responsible for their parents' safety.
	My Bill would place duties on social services authorities to consider what support services are needed to sustain the parenting role in such families. When a parent is assessed for community care services, support services should be offered if it is found that the adult relies for support on the caring role of his or her child. In that way we can ensure that the health, education and well-being of the child or young person are not impaired by caring responsibilities.
	Young carers may have a parent with an illness such as multiple sclerosis, or with a learning or physical disability. The parent may rely on the care from their child, as a case known to the Princess Royal Trust for Carers illustrates. A single parent was diagnosed with multiple sclerosis and loss of mobility, which affects not only her but her children, aged 8 and 12, who have to provide her with the round-the-clock support she needs.
	Such children are missing out on their education and, like other young carers, they find themselves misunderstood at school, treated as truants and bullied by other children. Schools need written policies stating the support that they will offer young carers. My Bill would require that both schools and local authority children's services have policies in place to support such young carers.
	Many health and social care professionals are frustrated by the difficulties they experience due to different thresholds for service provision for different client groups. An adult mental health worker may be aware of several children affected by their parent's mental health condition. However, unless the children are at risk of serious harm the health professional will probably not be able to help them. The general duties to young carers and their families outlined in my Bill would help. A simple joint working protocol between children's and adult services, combined with a training programme for staff, would help to solve the problem.
	Census figures tell us that a minimum of 2 per cent. of all children in the UK are young carers. However, work by Professor Saul Becker of Nottingham university and others suggests that the true number of young carers could be much higher—possibly 1 million of the 3 million children and young people who live in families where there is serious illness or disability. Whichever figure we use, we need now to bring in measures so that schools and local authorities recognise the issues faced by young carers.
	I have outlined how the measures in my Bill would ensure that health professionals identify carers and refer them to much needed help and support. As we move towards the Government's review of the national strategy for carers, I hope the measures outlined in the Bill will offer a sturdy framework for improved services and support to carers. My Bill is supported by Carers UK, Contact a Family and the Princess Royal Trust for Carers. I thank Carers UK and Luke Clements for helping me to draft the Bill and Alex Fox of the Princess Royal Trust for Carers for his input on young carers. I also thank the House for giving me the opportunity to present it today.
	 Question put and agreed to.
	Bill ordered to be brought in by Barbara Keeley, Tony Baldry, John Bercow, Mr. Paul Burstow, Annette Brooke, Dr. Hywel Francis, Helen Goodman, Lady Hermon, Mrs. Sharon Hodgson, Ms Diana R. Johnson, Ms Sally Keeble and Lynda Waltho.

Carers (Identification and Support)

Barbara Keeley accordingly presented a Bill to require health bodies to identify patients who are carers or who have a carer; to require identified carers to be referred to sources of help and support and to make further provision in relation to such arrangements; to make provision in relation to the responsibilities of local authorities and schools for the needs of young carers and their families; and for connected purposes: And the same was read the First time; and ordered to be read a Second time on Friday 19 October, and to be printed [Bill 92].

Opposition Day
	 — 
	[9th Allotted Day]

Modernising Medical Careers

Mr. Speaker: I have selected the amendment in the name of the Prime Minister.

Andrew Lansley: I beg to move,
	That this House acknowledges the UK's exceptional history of medical training which has produced some of the best medical professionals in the world; supports medical training designed to improve patient care which is well implemented, flexible and applied in a way which ensures the necessary level of clinical experience; believes that these objectives have been undermined by poor planning, inadequate consultation and lamentable implementation; notes with particular concern the flawed electronic application process (MTAS) which has breached legitimate expectations that selection for entry to programmes must be open, fair and effective; regrets the lack of ministerial leadership for MTAS and the failure of the Government's review to deliver strategic solutions; accepts that training posts are competitive but believes that insufficient allowance has been made for the number of trainees coming through the Foundation years in addition to the Senior House Officer (SHO) route; calls on the Government to create additional training posts to allow transition for SHOs into specialty training in 2007, 2008 and 2009; deeply regrets the distress and loss of goodwill among junior doctors in training; and further calls on the Review Group led by Sir John Tooke to listen to the medical profession in reviewing the structure of Modernising Medical Careers to ensure that the original principles, including flexibility, are sustained and command the confidence of the medical profession.
	The reason why we have called this debate and given up Opposition time to such an important subject is that time and again we have sought answers from the Secretary of State for Health and Ministers about what has happened to the modernising medical careers programme, in particular the recruitment and selection process. With your consent, Mr. Speaker, we put an urgent question that the Secretary of State had to answer, because previously she had provided no good answers. Last Monday, she came to the House to apologise unreservedly—about time—but also to announce a further review and the conclusions of the first review group she had instituted. Serious questions and issues remain, however, and many junior doctors across the country and the consultants responsible for the interviewing process feel they have not been answered.
	Our purpose today is therefore threefold. First, we want to secure some answers; secondly, through our motion, we want to make clear the necessary steps that the Government should accept to regain the confidence and support of the medical profession; and thirdly and not least, we want to demonstrate to the many junior doctors who have come to Westminster today to tell their Members of Parliament of their personal experiences, their disillusionment and, in many cases, their anger at what has happened to them that Conservative Members at least understand and accept their views. I suspect that many Labour Members, on the Back Benches at least, understand the problem. We will see later whether they are willing to come to the House to express to Ministers the sentiments that they have no doubt expressed to their constituents in private.

Nick Palmer: Does the hon. Gentleman agree that whatever the flaws or otherwise of the electronic system, the underlying problem is the surplus of applicants compared with places? Will he commit his party to increasing funding to the health service by the same level as we are committed to doing so that these doctors have a real prospect of a future in the NHS in the years to come?

Andrew Lansley: The hon. Gentleman must know that, in the general election the year before last, we committed ourselves to exactly the same level of funding as applies now. However, we are talking not about the next election, but about what is happening now. We are committed to the same level of funding, but we are also committed to a far more efficient use of that funding.
	The hon. Gentleman could have said, "By the way, the Government spent £72 million on the NHS university," but that turned out to be completely wasted. What was their response to that waste of money? It was to try to suppress the report by Sir William Wells that was designed to examine where all that money had gone. Let us first be concerned with spending money effectively before we start debating how much money there will be beyond the comprehensive spending review.
	The Secretary of State is sometimes at pains to challenge us on whether we agree with the principles behind modernising medical careers. Yes, we agree that modernising medical careers is a necessary process. To put it at its simplest, let us consider whether services in the NHS should be provided in the long run by specialist doctors or by doctors in training. Patients and the public would expect the services to be delivered by specialists and that it would be a consultant-led and increasingly a consultant-delivered service. When one looks across the world, one sees that this country has been unusual in the extent to which services in NHS hospitals, in particular, have been delivered by doctors in training rather by doctors who have their specialist certificates.
	The principle of modernising medical careers is accepted and we also accept many of the principles in the documents of 2002 and 2004 that led to it. We should not rely on doctors in training for service delivery and training must be limited in time. It cannot be open-ended. As Sir Liam Donaldson said in his report about the "lost tribe" of senior house officers, we cannot have junior doctors who drift from one SHO job to another for years without ever making progress in specialist training.
	Let us remember that one of the principles of MMC was that it was intended to be flexible and widen career choice. Where did that one go in the translation of principles into practice? The way in which MMC has been implemented is lamentable. When people look at the political gravestones of the figures in the Government, they will see carved on them, "It should have worked in principle, but it didn't work in practice." The Government started out with good intentions, but time and again they have failed to deliver. Here is another lamentable and shocking example of how they have failed to turn what, five years ago, was a straightforward set of principles into something that works in practice for those in the NHS today.

Henry Bellingham: My hon. Friend is putting forward an excellent case. Like many hon. Members, I have been meeting young doctors, including some who are now going to go abroad. Those doctors are worried that they will not receive sufficient training under MMC. For example, orthopaedic surgeons received 22,000 hours of training under the old system, but they will receive only 6,000 hours of training under MMC. There might well be a happy medium, but the Government have certainly not got this right.

Andrew Lansley: I understand exactly the point that my hon. Friend makes. I have had exactly the same conversations. I think that most junior doctors would acknowledge that it would be difficult to sustain the degree of clinical experience that used to obtain and that that would probably not be consistent with the delivery of services by specialists. However, my hon. Friend is right that there is a balance to be struck. Surgical specialties, especially, are, in effect, crafts as well as academic disciplines. While the structure of MMC and its focus on specific competencies address important issues, the programme has significantly failed to reflect accurately the importance of clinical experience and academic achievement, which should be involved in the selection of candidates.

Several hon. Members: rose —

Andrew Lansley: I give way to my hon. Friend the Member for Worthing, West (Peter Bottomley), who has done an enormous amount to represent the views of junior doctors on this subject.

Peter Bottomley: I, like Ministers, care about what is happening, but perhaps Opposition Members have been more open about some of the problems. Locally, we have discovered that filling out 150 words is worth the same as a PhD, which involves three years or more of hard work. An explanation of that is needed. On the first day the system opened, it was apparently not possible to apply for a job within 50 miles of Worthing or for one in genito-urinary medicine. The problem is not the computer or the method of consulting the people who put the thing together. The problem was caused because the system was not run as a trial in at least one region to evaluate the experience. Will my hon. Friend commit us to go on working not only for senior and junior doctors, but for those in the MMC system who resigned because of a loss of confidence, by backing the doctors and, if necessary, saying to the Government, "Why don't you drop your defences and join in working out the problems and solving them?"

Andrew Lansley: My hon. Friend has captured exactly what we are trying to achieve through this debate. If hon. Members read the motion, they will see that its objective is not to engage in the easy task of saying, "It's all gone wrong and the Government are to blame." The motion engages with the question of what needs to happen now, although I note that the Government amendment says nothing at all about that.
	The Government have been given warnings and they have to account for why they did not accurately reflect on the problems. The hon. Member for Broxtowe (Dr. Palmer), who asked the Whips' question and then left the Chamber, said that this was about the number of applicants. However, I remember standing at this Dispatch Box on 20 December 2005 and making it clear to the Secretary of State that there would be a problem in August 2007 because two year cohorts of applicants would be coming together in one year, so the number of applicants for training posts would effectively double. The Secretary of State said that that issue had to be addressed. With a year and a half in hand, I was foolish enough to imagine that she would solve the problem. When, on 13 December 2006, Lord Warner said that junior doctors in England should be pretty confident about securing a training post and that additional training posts would be created, I was foolish enough to think that the Government had considered the situation and arrived at a solution.
	There was a good deal of forewarning. The royal colleges rightly told the Government that the programme should be piloted, as my hon. Friend the Member for Worthing, West suggested, but that did not happen. Last year, junior doctors in the British Medical Association wanted a delay of a year. To be fair, I was not sure that that was the right thing to do because it would have harmed the circumstances of the foundation programme graduates. None the less, the BMA was rightly pointing out serious unresolved problems.

Evan Harris: I strongly support the hon. Gentleman's motion. Does he agree that the key point about MMC is that the number of training posts will not meet the need of the people who want to apply? The principle should be that all those who are qualified for a training post, and who are capable of being trained to consultant level and wish to be trained to that level, should have a training post; otherwise, we are wasting money by putting them through medical school and house jobs. A solution in which those people are parked in career-grade posts, so that they become fellows or hold staff grades or trust grades, is not acceptable, because then the service will be delivered not by consultants, but by a demoralised and often racially segregated group of doctors who are not fully trained and who are not specialists—and that is not the way we want our health service to go.

Andrew Lansley: The hon. Gentleman is leading me further into what I was hoping to say. Let me just respond to that point. From what I know of the interviews that are already taking place, many consultants holding the interviews are meeting well- qualified applicants; I see that the Secretary of State is nodding merrily. However, unfortunately, we know that many well-qualified applicants did not get interviews. As the hon. Member for Oxford, West and Abingdon (Dr. Harris) suggests, we need a process in which well- qualified junior doctors have progressive opportunities to enter specialty training, and that is what our motion says. It also suggests that it may not be possible for all well-qualified applicants to secure specialty training or run-through training posts this year, but we have to put a stop to the current structure, which, in effect, limits the ability of some people, particularly senior house officers, to enter specialty training next year, or the year after that, if they do not enter the run-through training process this year.

Julian Lewis: Surely specialisms are to be held by the people best qualified to fill the posts, but how can that be reconciled with a situation in which people are confined to applying for posts in certain geographical areas? That means that if there are only two or three posts going in an area, and someone is the third or fourth best qualified person in the area and so does not net the post, they are unable to qualify, or even to apply, for similar posts in other parts of the country, even though they may be much better than the people who are allowed to apply for those posts.

Andrew Lansley: I am grateful to my hon. Friend, who makes an important point. He reminds us of the most important reason why we are debating the subject. I have received hundreds of e-mails on the subject, and I have met many constituents, as I am sure that colleagues from across the House have done, who are concerned for their careers, for their livelihoods, for the fulfilment of their vocation to be a doctor and care for patients, and often for their family life. I ask hon. Members from across the House to imagine how they would feel if they were junior doctors—highly motivated professionals who have gone through graduate education, and who have, in some cases, worked in the health service for several years. They are senior professionals by any measure, but the net result of the current structure, including the way in which the review group has changed things, is that there is one interview for one unit of application, and that might be for a post anywhere in the east of England, from Hemel Hempstead to Cromer. That is the sum total of their ability to exercise control over the future of their career.

John Bercow: Dr. Mary Weisters and Dr. Tracy Graves practise general surgery and neurology respectively. Between them, they have 25 years' experience, which includes education, training and hands-on practice in the national health service. According to the figures, they have a one in 30 chance and a one in 13 chance respectively of securing a job at a time of rising demand for medical services. Does my hon. Friend not agree that it would be a scandal bordering on criminal irresponsibility if they were shunted out of the national health service or, as happens at present, patronisingly encouraged to go abroad—something that they do not have the slightest desire to do?

Andrew Lansley: I am grateful to my hon. Friend, because he further reinforces my point. I have often met married junior doctors who are wrestling with the issue of how they can both secure posts in a way that is consistent with maintaining their family life. That is intensely difficult. My hon. Friend's point is a fair one; the British Medical Association is today warning that literally thousands of junior doctors could end up going overseas. What is the Government's response? Well, we saw the document produced in the Department of Health last week. It was not published, but it found its way out. The Government are "volunteering" junior doctors to join Voluntary Service Overseas, so that they go abroad.  [ Interruption. ] Well, it struck me that VSO is about volunteering—not the distressed reallocation of doctors from the United Kingdom to overseas, which is outrageous.

Tony Baldry: Further to the point made by our hon. Friend the Member for Buckingham (John Bercow), how do I explain to my constituents at the Horton hospital that we are likely to lose 24/7 consultant-led paediatrics, consultant-led obstetrics and a special care baby unit in the near future, because we have been told that there are insufficient doctors? How is a community like north Oxfordshire to accept on the one hand that there is a substantial downgrading of NHS services in Banbury and the surrounding area in a way that has never taken place before, while on the other it can see that junior doctors are being thrown on to the scrapheap?

Andrew Lansley: There is only one way for my hon. Friend to explain that to his constituents: it is chronic mismanagement of the national health service by the Government. It was the Government's intention to continue the expansion of consultant posts, but that has been torpedoed by the mismanagement of finances and deficits in the health service so that across the NHS posts have been frozen, consultant posts have disappeared and specialist consultants in some specialties cannot find posts. The consequence is seen not only in the impact on Horton hospital in my hon. Friend's constituency, but across the country. The increase in medical school output or in the number of junior doctors coming through would have been consistent in due course with a larger throughput into consultant posts, but the Government's attitude is that those consultant posts have been lost for financial reasons and they are cutting back on the hospital sector, so they want to maintain a tight bottleneck at the point at which junior doctors enter the further reaches of specialty training. They are stopping the flow, and they are literally forcing large numbers of doctors to leave the country.
	The Government may believe that the doctors who will leave this country will be those who came from overseas in the first place, but that is not how it is working out. It is an arbitrary system. The scoring system, recruitment and application system have been made "objective" in a way that has become virtually arbitrary. Those who are selecting candidates for posts across the country were unable in the initial process to see anything like sufficient of the clinical experience, the academic achievements and the character of the candidates presented to them. It turned into a scoring system in which someone could literally—I have evidence in my file—pay £129, go on a course, and be told how to answer the questions to be selected for interview. That is utterly outrageous.

Michael Jack: Following my hon. Friend's extensive research for this debate, can he explain why there is such a misfit between the 30,000 junior doctors who started out with an aspiration to reach those higher posts and the 22,000 opportunities that exist? Who created that over-supply of 8,000 junior doctors, and has he worked out the cost to the economy, never mind the human cost, of that enormous waste of unplaced talent?

Andrew Lansley: My right hon. Friend may be aware that we are constantly searching for accurate figures as to precisely how many applications and run-through training posts there are. Of the 18,500 posts in England—I think that the Department would acknowledge that figure—we have not even been told how many are run-through training posts and how many are fixed-term posts. The disparity between the figure of 18,500 and anything up to 34,000 posts is principally the result of the combination of two annual cohorts coming together because the new MMC process is shorter than the old training process, the right of European economic area nationals to apply without legal restrictions in this country, and a large number of overseas doctors who, for example, have highly skilled migrant programme visas.
	There is no reason, as far as I am aware, why the Department should not have anticipated all those components. As little as four months ago, the Department, in the guise of the former health Minister, Norman Warner, was about a third out on the number of potential applicants. It is not good enough for Ministers to say, "There were more applicants than we expected so it all went wrong." They were responsible for the process. They are responsible for the number of junior doctors who have access to training in this country. They should have known the likely outcome and dealt with it.
	Time and again we have told Ministers that thousands of junior doctors would be left without training posts. The response of the Secretary of State is always to misinterpret that and say, "You're saying that they are all going to be unemployed, and that's shroud-waving." She said on 19 March that
	"the shroud-waving about unemployed doctors is absurd."—[ Official Report, 19 March 2007; Vol. 458, c. 582.]
	In a letter to me on 27 March she stated:
	"It is wrong to conclude . . . that there is a danger that these doctors will be unemployed"—
	 [Interruption.]
	The Secretary of State says that is right, but in her own Department a document is being circulated, the purpose of which is to try to deal with the fact that up to 10,000 junior doctors will be unemployed. That is what it says—unemployed or without training posts. It was not absurd. We were not shroud-waving. It was a fact and the Government knew it, but they would not admit it.
	The Secretary of State has been in appalling denial about all this. I shall try to avoid a long quote, but I want the House to listen to the words of one consultant who wrote to me describing the process from the interviewer's point of view. We are hearing from junior doctors about how appalling the process has been. The consultant wrote:
	"Today was the first occasion in 20 years that I was asked to make important decisions on the careers of our future colleagues, with no CV or application form to review in preparation for the face-to-face. The only information I received was a list of candidates—in no particular order—and a start time and venue. Each candidate arrived armed with a brief one-page summary, hand-written immediately prior to interview and a portfolio the size of one or two telephone directories. Three colleagues and I were supposed to review these in 30 minutes flat, at the same time as we conducted a structured interview, marked each domain individually, and finally came to an agreed score for each domain that will be forwarded to MTAS . . . I never saw any references and there was no opportunity to review our decisions. This process is the antithesis of fair employment and equal opportunities."
	That is from the consultant's point of view. Imagine how it seems from a junior doctor's point of view. I have a quote from a junior doctor who describes his experience. He states:
	"I have a first-class degree in medicine/neuroscience, medical degrees with distinction, two research doctorates . . . in behavioural neuroscience, nearly 30 scientific publications including text books and commercialized research software, research prizes, three years' experience as a lecturer in neuroscience at the University of Cambridge, and two years' experience as a medical SHO at teaching hospitals . . . whilst I was short-listed for an ST2 medical position I failed to be shortlisted for ST1 psychiatry, which requires no previous psychiatry experience. Presumably, in some way my answers to the 'anecdote' questions didn't fit the psychiatry scoring system, whatever that was".
	That reflects precisely the point made by my hon. Friend the Member for Worthing, West. A candidate can end up with all those qualifications but fail to be shortlisted because of the scoring system, under which a PhD was worth one point and 150 words on how one copes with stress was worth four points.

Peter Bottomley: Perhaps one should ask whether the Prime Minister would appoint the Front-Bench health team on the same kind of system. Will my hon. Friend join me in posing a question to the Secretary of State for answer at the end of the debate? Is it true that the review group has said that each candidate will get one interview in their primary area? Is it true that under the MTAS system people who are to be interviewed this weekend are being told that there are no jobs available—that all were filled on the first round, so they cannot select their first choice? The advice is that they contact the deanery directly. The Secretary of State shakes her head. Will my hon. Friend join me in asking her to get that checked by the end of the debate and tell the House what applicants are being told under the system today?

Andrew Lansley: I am grateful to my hon. Friend. I am sure that the Secretary of State heard what he said, and I hope she will respond. On interviews, I suspect that she is not looking forward to the one with the next Prime Minister.
	The Secretary of State has been in denial. She has told the House about the outcome of the review group. In a letter to me on 27 March she stated:
	"The Review Group is independent and responsibility for membership rests with Professor Neil Douglas".
	But a freedom of information request to the Department secured the answer:
	"I can confirm that Clare Chapman, Director General of Workforce at the Department of Health, had overall responsibility for considering who was appropriate to sit on the review group."
	It was not independent at all. It is no wonder, given the lack of a strategic solution from the review group led by Professor Douglas, that the Secretary of State has had to announce a new and a second review.
	Professor Crockard, who was responsible for the modernising medical careers process, resigned, and in a letter to Liam Donaldson, the chief medical officer, said:
	"I have become increasingly concerned that the well intentioned attempts to keep the recruitment and selection process running have been accompanied by mixed messages for the most important people in the whole process—the young doctor applicants."
	It is basically unfair to advertise the possibility of four interviews and then suggest that these might not be honoured. Shelley Heard, the clinical medical adviser to the MMC process, said:
	"The Review Group has not done this strategically or with an eye to the future."
	This is why we are here this afternoon. The Secretary of State and the Government are in denial about the scale of the process and the many difficulties and problems with the scoring system and the recruitment process, which I have not had time to go through, and are not coming forward with viable solutions for the future.

David Taylor: The hon. Gentleman makes a fair point about the lack of independence of the first review group, on which the great majority had close involvement with the creation of the MTAS and the modernising medical careers project. Does he hope that Professor Sir John Tooke, in agreeing the complement of his review group, will not include anyone who has played any part in any of the processes that have had so many problems during the past few months and years?

Andrew Lansley: I am grateful to the hon. Gentleman for that. The Secretary of State will no doubt tell us more in a moment, but she has this afternoon announced the terms of reference for Sir John Tooke's review: that it will be independent of the four health departments—good; and that it will have an independent secretariat—good. But there are two problems. First, she has not announced the membership, and I entirely endorse what the hon. Gentleman said. It is essential for the confidence of the medical profession that Sir John Tooke's review is conducted by people who are in no sense, whether positively or negatively, associated with the decisions that have hitherto been made about the MMC and MTAS processes.
	The other problem with what the Secretary of State has announced this afternoon is that she is asking Sir John Tooke to report on an interim basis in September. Hon. Members will know that the problems that we are encountering now with the outcome of the second review group will come to a head in August, so she appears to be precluding the possibility of Sir John Tooke and his colleagues, whoever they may be, intervening more or less immediately to say that steps need to be taken.
	The Opposition motion includes essential measures. The review still has serious problems and it will be subject to legal challenge. There is a good argument that legitimate expectations of junior doctors in the application process have been completely failed, and there are still problems in trying to manage the application process. People cannot obtain interviews and are being logged out and obstructed, and there is scope for gaming for those who have already had interviews. To that extent there is an uneven playing field between those who had first round interviews and those who are in round 1B. It is astonishing that in England junior doctors are being restricted to one interview, whereas in Scotland and Northern Ireland all four original interviews are being offered.
	It is far from clear that consultants throughout the country will be prepared to participate in what they regard as an unfair recruitment process. The consultants at Addenbrookes in my constituency sent me the results of a consultant survey that they had recently undertaken, and three quarters of those consultants said that they would refuse to take part in further interviews. Ninety-seven per cent. of them wanted to see the previous system of appointments restored for this year. I do not necessarily agree with that. However, there is something that we can and must do between now and August. It is not good enough to wait for Sir John Tooke's review in order to produce a report in September. We must consider foundation programme graduates who should, in all cases, be able to access specialty training. If they are not getting access to that training, posts will need to be created to enable that to happen. That was clear from the original principles of MMC, as stated in April 2004 in "Modernising medical careers: the next steps":
	"It is not acceptable that they"—
	that, is foundation programme graduates—
	"should at this stage fall out of the training system".
	Yet, according to the Department's own document, between 500 and 1,300 such foundation year graduates might fall out of the system.
	It is not acceptable that this shambles means that large numbers of senior house officers, many of whom have excellent clinical experience, good academic qualifications and fine references, are going to be closed out of the ability to enter specialist training. We must turn more trust grade posts into training posts. I said that to the Secretary of State on 19 March, when Ministers sat there barracking me, saying, "That is extra money; it's going to cost." Of course, as we now know from a document sent to hospital trusts and strategic health authorities on 5 April, that is exactly what the Department is doing. It has asked hospital trusts and SHAs to respond by 27 April. Will the Secretary of State now commit to an increase in the number of training posts available this year and the holding back of some run-through training posts for 2008 and 2009 so that, as the hon. Member for Oxford, West and Abingdon said, senior house officers—those who have a legitimate expectation of completing their specialty training—will not suffer the guillotine that cuts off the possibility of their securing the appropriate level of training this year, next year or the year after?

Evan Harris: The hon. Gentleman is absolutely right. He is also right as regards the financial cost, or otherwise, of converting staff grade posts and trust grade posts to junior doctor training posts. Clearly, some service functions may have to go with the loss of those service posts, but I think that most junior doctors will be prepared to do some supervised service as the price of having a career in training. Does he agree that if the Government plan junior doctor posts, there must be some central planning to get the consultant expansion that is needed to underpin all of this?

Andrew Lansley: On the latter point, it is fair to say that one of the essential things that John Tooke must do is to establish a new work force planning arrangement that is owned much more by the profession and the service than by the Department of Health, which has handled it so appallingly.
	The hon. Member for Oxford, West and Abingdon makes an important point. As I am sure that the Secretary of State would agree, turning trust grades to training posts is not without cost. That would have to come from the MPET—multi-profession education and training—budget in strategic health authorities. The Government have admitted that in the last financial year—2006-07—they cut £350 million from education and training budgets. Three or four weeks ago, the chief executive of the NHS said that that was for one year only. We are now at the start of the new financial year. It is clear from the SHA board papers that some SHAs are already planning to cut £136 million out of their training budgets for this financial year. We know where the money could come from for more training posts, because there is money in the training budgets, yet the Secretary of State sits there saying that the Department cannot afford them. It could afford them were it not mortgaging the future of the NHS to deal with its financial mismanagement to date.
	Let me make it absolutely clear what we want. On 30 March, I sent the Secretary of State a letter with 101 e-mails that I had received from junior doctors about the many problems that they had experienced. I have had no reply. Senior house officers cannot become another new lost tribe of junior doctors in whom we, as the public, have invested not only our taxpayers' money but an enormous amount of our emotional support in the best young people of this country who have chosen to go into medicine but who might end up never being able to fulfil their vocation or, worst of all, pursuing it overseas, so that all those investments have been lost

Justine Greening: It is not only a matter of the time and energy that junior doctors put into getting qualified but the massive student debt that they incur. Medical graduates now have an average debt of £21,000.

Andrew Lansley: It is no wonder that not only Australian medical recruiters who come to this country but the City try to recruit junior doctors. Some of them will understandably be tempted precisely because of the point that my hon. Friend makes.

Frank Field: The hon. Gentleman says that we should ensure that there are career prospects for our best young people in this country. Given the unique circumstances that give rise to the issues that we are debating—two strings of training are concluding in one year—does he believe that the Government should ban doctors from Europe from applying for jobs in this country? Given that Europe takes so long to respond to anything, the year would be over and we would be into a second one before it had caught up with what we had done.

Andrew Lansley: I am grateful to the right hon. Gentleman but I fear that, legally, his suggestion is impossible. I do not propose it because I do not believe that the Government could legally take such action.
	We cannot allow investment in junior doctors to be abandoned—that appears to be a risk as a result of the Government's policies. The vocation to serve patients in our national health service must not be lost to this country. The human needs of junior doctors—to pursue their career and maintain their family life—must not be ignored by the way in which the process is administered. We need to return to the profession greater control over its education and training. It is vital to find a solution that wins back the profession's confidence, which the Government have lost.
	It is vital that Sir John Tooke's review not only has the option of making immediate recommendations but can be independent, representative of the profession and the service, open in its analysis—not closed, as previous review groups have been—and strategic in its outcome.
	In a briefing paper for the debate, the Royal College of Physicians described what has happened as:
	"The worst episode in the history of medical training in the UK in living memory".
	The medical profession is rightly angry. Its members have been disempowered and they are demoralised. That has happened on the Secretary of State's watch. We have brought her to account and we want a solution. The Government's amendment makes no reference to the appointments and recruitment systems or MTAS. Worse, it contains no expression of regret. Our motion expresses on behalf of Parliament our deep regret about the distress caused to junior doctors and the loss of good will in the medical profession. We do not hear that from the Government. That is why hon. Members should reject the amendment. I commend our motion to the House.

Mr. Speaker: Before I call the Secretary of State to move the amendment, I point out that a demonstration took place in the Public Gallery. I know how seriously members of the public take the matter and I understand that things can get heated. However, I must tell the House that, if there is another demonstration, the Serjeant at Arms' officers have the authority to clear the Public Gallery. That might be unfair to those who have travelled a long way to hear the debate.

Patricia Hewitt: I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:
	"recognises the international reputation for excellence of medical training in the UK; acknowledges the need to modernise medical careers to ensure all doctors are properly trained to nationally recognised standards, including a fairer and more transparent process for applying for specialist training; notes that Modernising Medical Careers (MMC) will deliver training to a consistently high standard which, combined with the expansion of the number of doctors, will provide high quality safe care by appropriate skilled medical staff; notes the wide consultation that took place on MMC and the strong support for the need to improve doctors' training amongst doctors' representatives including the medical royal colleges and the British Medical Association; welcomes the external review that is already being conducted into how MMC has worked to date and the changes made as a result; and supports the longer term review recently announced to ensure MMC works well in the future."
	Let me begin by stressing, as I did last week, that my ministerial colleagues and I are in no doubt about the distress, anxiety and uncertainty that has been caused to junior doctors by the problems with this year's applications system. Those problems should not have arisen, but they have, and we are all—Ministers, officials in the Department, the medical royal colleges, the British Medical Association, the postgraduate deaneries—completely focused on sorting them out so that, as I said to the House last week, we have a system for this year that is fair to junior doctors and enables the NHS to make the right appointments to all the posts involved.
	In addition to the urgent questions that the hon. Member for South Cambridgeshire (Mr. Lansley) mentioned, there have already been three written ministerial statements as well as last week's oral statement. I will, of course, continue to update the House on the work of the review group under the leadership of Professor Neil Douglas, which will remain in existence while we continue to sort out the problems that have arisen with this year's applications system.
	Before I return to the question of the applications system and look forward to Sir John Tooke's review, I want to say a little more about the new medical training system and what it replaces. As on previous occasions, the hon. Gentleman has simply understated the very real problems of the old system that modernising medical careers replaces. That system, as the whole House would acknowledge, has always produced outstanding doctors for the NHS, many of them world leaders.
	However, that system was also wasteful, inconsistent, often unfair and, indeed, as the Royal College of Surgeons said several years ago, "most unsatisfactory". Some junior doctors had to apply for a new training post every six months. They were sending in different applications in different formats to different hospitals and different post-graduate deaneries at different times of the year. There was no proper national curriculum and no standardised assessment process. It has always been the case that, because of the intense competition for medical training posts, junior doctors who could not secure the senior house officer job that they wanted found themselves filling in time in the wrong post—from the point of view of the skills that they wanted to develop—in non-training posts or as a locum. Sometimes, as Conservative Members pointed out, they had to do so for years on end.
	Remedy UK, the newly formed group that has been so critical—understandably so—of this year's problems says in its briefing paper on MMC that many of those in the old senior house officer job were in short-term or non-training posts or endured poorly planned training with no clearly defined end points. There were certainly deficiencies in the selection and appointment procedures, along with inadequate supervision, assessment and career advice. It was precisely because of those problems that, following the leadership of the chief medical officer, the Department of Health sat down with the medical royal colleges, with the British Medical Association, with the postgraduate deaneries and others—including, of course, representatives of the junior doctors—to devise modernising medical careers, which almost everybody agrees is the right way forward. Indeed, Professor Douglas's review group has confirmed that.

Desmond Swayne: The right hon. Lady is setting up a straw man. Absolutely no one here is trying to suggest that we should have stuck with the original system. Her job here today should be to explain the shambles that we are now in and how we are going to get out of it, rather than to review what might have been the case in the past.

Patricia Hewitt: I have to tell the hon. Gentleman that in a debate titled "Modernising Medical Careers", it makes sense to remind the House of how it came about, why we committed to it in the NHS plan of 2000 and why its underlying principles and direction of reform for medical training are absolutely right.

Evan Harris: I share the right hon. Lady's view that the problem with the old system was that too many doctors at senior house officer level had nowhere to go to get into training, so they had to mark time, go into career grade posts or SHO posts that were not really training posts. Does she accept that the test of the new system will be how many fewer people in that situation either have to leave training against their will when they are capable of being trained to be consultants or have to go unwillingly into career grade posts below specialist training level? Does she accept that that will be the test of the success of her new system?

Patricia Hewitt: What I accept in response to the hon. Gentleman's question is that it has never been possible for every junior doctor who wants to pursue training through to a consultant post to do so, particularly in the specialty that they originally wanted to follow. I will come back to that point in a moment.

Nadine Dorries: Will the Secretary of State give way?

Patricia Hewitt: I want to make a little more progress before I give way again.
	The first part of the new system—the two-year foundation programme—was successfully introduced in 2005. In line with the principles that will operate throughout modernising medical careers, that will give every medical graduate a series of properly supervised placements in medicine, surgery and a range of other specialties and settings, with formal training based on a national curriculum developed following wide consultation with the profession, including the medical royal colleges, and approved by the Postgraduate Medical Education and Training Board. It will also provide our medical graduates with regular workplace-based assessments of competence, a national learning portfolio and formal access to careers advice, all of which were missing from the old system.

Nadine Dorries: rose—

Patricia Hewitt: If Opposition Members support all that, I shall be delighted. I shall give way to the hon. Lady.

Nadine Dorries: As my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) has said, there is no argument about the fact that doctors' careers and training processes needed modernising. The issue is that the process has been a complete, unmitigated disaster, yet the Secretary of State is not accepting responsibility for that.

Patricia Hewitt: I am sure that the hon. Lady will not accept my word for it, but if she just looks at the several statements made by the review group under Professor Neil Douglas, she will see that it has not been a complete, unmitigated disaster. The applications system has actually been working well in many places, particularly for GP posts. Many problems have arisen that I have acknowledged since the scale of the problem became clear and taken action on, particularly by the appointment through the Academy of Medical Royal Colleges of Professor Neil Douglas to lead the review group and to sort out the problems. Just as I am acknowledging the problems, I wish that the hon. Lady and her hon. Friends would acknowledge that we are taking this matter seriously. We have apologised for the fact that the problems arose, and we are now seeking to correct them and to sort this out.

Lynne Jones: A serious problem exists today, but the review group will not report for some time. I listened carefully to the hon. Member for South Cambridgeshire (Mr. Lansley), and there was nothing in his speech that I could disagree with. My right hon. Friend cites Remedy UK; I met one of my constituents this morning, and they are calling for more training posts to be created. There is nothing in the Government's amendment today to tell us how we are going to get out of this situation, and I hope that my right hon. Friend will address that problem.

Patricia Hewitt: That is precisely the point that I am coming to, but I wanted first to make the rather important points about why we are changing to modernising medical careers.

Michael Jack: Will the Secretary of State give way?

Patricia Hewitt: No, I want to make some more progress before I give way again.
	As I told the House last week, Professor Douglas's review group has already agreed on significant changes to the system. They have been announced to the House and to junior doctors, and they are now being implemented. The review group decided, after careful discussion, that it would be wrong to abandon the process of interviews that is now under way. It concentrated instead on how to change the process so that it would be fair to junior doctors and meet their needs and the needs of the NHS as a whole. In particular, every eligible applicant was invited to reaffirm or revise the order of their application preferences and was guaranteed at least one interview for their revised first preference specialty. That is now happening and, over the past few days, more than 25,000 applicants have taken the opportunity to revise the order of their preferences and have done so successfully on the much-maligned medical training application system—MTAS. Those interviews are now under way, and they will continue right through next month.

Michael Jack: I am grateful to the Secretary of State for her courtesy in giving way. Will she put on record for the benefit of the House the fact that, while receiving submissions from her officials when the new training methods were being devised, she never received any message at all from any official or from anyone concerned with medical training or medical manpower planning that there would be a problem with two streams of trained doctors arriving at the same time and chasing the same posts? Did she ever receive such advice?

Patricia Hewitt: Last year, the main focus of the discussions, particularly with the British Medical Association, was on the number of training posts that would be available. That is not dictated by Ministers or the Department of Health; it is determined by the individual trusts and postgraduate deaneries on the basis of what is needed by the service. We spent several months and a great deal of work establishing the number of training posts that would be available. The noble Lord Warner, then the Minister responsible, made a statement on that subject towards the end of last year— [Interruption.] If I may remind the right hon. Member for Fylde (Mr. Jack), Lord Warner said in that statement that we did not and could not know how many other applicants there would be, particularly from overseas.

Frank Field: The junior doctors who have been in contact with me are not now so concerned about the process, which they find rather academic, but they are desperately worried about their jobs. When the crisis began to unfold, the Prime Minister said that he expected that the vast majority of doctors coming up for appointment would gain appointments. Will my right hon. Friend have an opportunity this afternoon to outline the measures that she has directed to ensure that that pledge is fulfilled?

Patricia Hewitt: First, in response to my right hon. Friend the Member for Birkenhead (Mr. Field), and to other questions, I want to clarify the total number of training places available: about 23,000 postgraduate medical training appointments are available across the UK this year, which is more than ever before. Of those, 3,000 are being filled by recruitment to general practice, and just over 19,000 places are available on MTAS at the moment, with a further 700 to be added to the system. We all know very well that there are more applicants than training posts. That has always been the case, but it does not mean, as headlines and some press reports claimed at the weekend, that there will be 10,000 unemployed doctors.
	Of the 32,000 or so eligible applicants for those training posts, about 30,000 are already working in the NHS, about 6,000 of whom are completing their foundation programme, and about 8,000 of whom state on their applications that they are working in non-training posts—trust jobs, staff jobs, locum posts and so on. About 16,000 say that they are working as senior house officers, but because of the deficiencies in the present system, many of those posts are not proper training posts either. Regardless of the outcome of applications for the new training posts, the NHS will continue to need all those jobs and possibly more in the future, because the number of patients is increasing, and so is the number of doctors—the NHS now has over 30,000 more doctors than 10 years ago.
	Someone who is currently working in the NHS in a non-training post, whatever it is called, who does not get the training post for which they applied this year, will be disappointed, just as many were last year, the year before and every other previous year. They will still, however, have their job. Those who do succeed in getting a training post will leave a vacancy that can be filled by a doctor—with appropriate experience, of course—who has failed to get the training post that they sought this year.

Rob Marris: A couple of years ago, the province of Ontario in Canada abolished grade 13, which led to a double cohort going to university, for which steps had to be taken. My right hon. Friend talks of posts for medical graduates, but the difficulty is that no steps appear to have been taken to plan for the inherent and entirely foreseeable problem of the double cohort of SHOs at one end and recent medical graduates at the other. SHOs who started under the old system are competing with recent medical graduates for an insufficient number of training posts—I stress the word "training" to my right hon. Friend. As I understand it, a lot of those people will be redundant from 1 August. Will she assure me that a sufficient number of training posts will be available for those doctors?

Patricia Hewitt: The number of posts must be based on the needs of patients and the service as well as the needs and wishes of trainees. As I have tried to stress, it has always been the case that some doctors in training have either had to change their specialties or been unable to progress in their training to consultant grade. The new system does not change those realities.

Andrew Pelling: rose—

Patricia Hewitt: I want to make a little more progress before I give way again.
	I fully recognise that it would be quite wrong to leave a junior doctor part-way through his or her training with no clear prospects. Until the whole process of interviewing and job placement is completed in a few months time, we will not know which trainees—whether they are just completing the foundation programme or are more senior—have obtained specialist training posts. However, I assure my hon. Friend and the House that we will give them proper support.
	As part of the review, we are working urgently with the royal medical colleges and the NHS to establish the need for additional training posts—which will of course have to be approved by PMETB, the Postgraduate Medical Education and Training Board—including one-year placements and more senior posts. We are also considering how we can provide more effective training support for doctors in service posts—that is, non-training posts—to maximise their development opportunities. That is the issue on which Professor Douglas's review group is now focusing, having dealt with earlier problems involving the application process, and it will make a full statement—as will I, to the House—on the support that will be available very shortly.

Andrew Pelling: rose—

Henry Bellingham: rose—

John Bercow: rose—

Patricia Hewitt: I will give way to the hon. Member for Buckingham (John Bercow).

John Bercow: The right hon. Lady referred to the needs of patients. When we envisage circumstances in which every junior doctor in every grade and in every specialty changes job on the same day, the spectre is inevitably raised, and was articulated to me only this morning, of wards either empty or massively understaffed, potentially thereby—I choose my words carefully—imperilling public and patient safety. The right hon. Lady shakes her head, and she is entitled to do so, but can she assure me that there will be no such scenario anywhere in the country? If she is confident that she can, will she say precisely what contingency planning is being done to enable her confidently to make that prediction?

Patricia Hewitt: As I have just said, the great majority of applicants who are already in non-training staff posts, trust posts and a variety of other non-training posts will still have those jobs because they will still be needed in the NHS. Each hospital trust, and the board of each trust, has a responsibility to its patients to ensure that on 1 August, or any other day, the right number of the right staff are available to provide safe, high-quality care.

Henry Bellingham: Further to the point made so eloquently by my hon. Friend the Member for Buckingham (John Bercow), is the Secretary of State aware that in my constituency Queen Elizabeth hospital has made it clear that because of the changeover date of 1 August, no elective work will be done during the first week of that month? All day surgery will be cancelled for a week, which will mean the cancellation or postponement of probably 100 operations and a consequent increase in waiting lists. Will that happen throughout the country, and why will it happen in my constituency?

Patricia Hewitt: The issue of the changeover date is nothing new. Trusts have to plan for it very year, and that is what they are doing this year. It is not exactly unpredictable or novel. As I have said, it is up to individual trusts to decide how to organise staff in order to meet their patients' needs.

Andrew Pelling: rose—

Patricia Hewitt: I want to make a little more progress before I give way again. I have been quite generous in taking interventions.
	We hear from Conservative Members and others demands for the creation of an unlimited number of training posts to meet the needs and wishes of junior doctors. We must recognise that it is necessary to balance fairness to doctors in training with the needs of patients and the NHS. It would be completely wrong to create a specialist training post for everybody who wants to become a consultant in a particular specialty, including for people who have in the past applied for training posts year after year, as some have done, and have not been able to progress in their training, or to create posts regardless of whether the NHS actually needs so many consultants in a particular specialty.
	Cardiothoracic surgery is an example of such a specialty. Because technology and medical practice have transformed how cardiothoracic patients are treated, the NHS already has far more fully trained cardiothoracic surgeons than it needs. This year alone we have 300 applications for five speciality cardiothoracic posts. It would not be right for the NHS to create another large number of cardiothoracic training posts simply so that there are enough for every applicant who would like to specialise in that field. Equally, however, those applicants who have that field as their first choice and who are disappointed must have the opportunity and support that they need to progress in another specialty. That is an important point, because what we need in terms of training—and I believe that we will get this with modernising medical careers—is a system that not only gives dedicated and excellent junior doctors the chance to progress in their careers, but enables the NHS to have the right number of people with the right skills at a time when medical practice and technology are changing faster than ever before.

David Heath: It is instructive that the right hon. Lady chose the small specialty of cardiothoracic work, which has always been oversubscribed, and it would be interesting to find out whether she can give any other such examples. However, may I return her to a question that she has still not addressed, despite having been asked it at least three times this afternoon? There was an entirely predictable consequence of the double cohort. What planning did the Department do to deal with the double cohort issue?

Patricia Hewitt: The hon. Gentleman is ignoring the fact that, because of how the old system worked—with junior doctors applying for jobs all over the country, and with different application systems and things happening at different times of the year—there was no national system. Therefore, we had no statistics in respect of the number of people who had been applying unsuccessfully for training posts. I agree that it is clear, with the benefit of hindsight, that it would have been better if we had predicted that almost everybody in a non-training post would take the opportunity of this year—the first year of a system that is much fairer and much more transparent, with more training posts available than ever before—to make an application. Of course it would have been better if we had predicted that. We failed to do so, and I have apologised for the problems and distress that that has caused. More importantly, however, we are now putting that right.

Andrew Pelling: I am grateful to the Secretary of State for giving way. What would her advice be to the four junior doctors from my constituency who visited me today, all of whom have been offered training posts, in Brisbane, Toronto and Singapore, bearing in mind that the offer being made by the Secretary of State is that they can have some kind of job in the NHS, even perhaps as a rural GP in Scotland—an example of "Dr. Finlay's Casebook", if ever there was such an example? Would her advice be that it would be best if, despite the £250,000 that has been spent on the training of each of them, they accepted those job offers outside the United Kingdom?

Patricia Hewitt: I am unsure whether the hon. Gentleman is prejudiced against general practitioners, or those working in country areas, or those working in Scotland. The job he mentions is in my view an excellent post, and I am sure that someone will fill it admirably. He also ignores the fact that 23,000 postgraduate medical training places will be available across the whole of the United Kingdom, which is more than ever before.
	Let me deal with the issue of doctors going abroad, which the hon. Member for Croydon, Central (Mr. Pelling) just raised. At the weekend, there was some quite disgraceful reporting in some sections of the press. On the one hand, they were busy saying how disgraceful it is that doctors have had to suffer the distress and added uncertainty of this year's difficulties, while on the other they ran a headline saying that they were all going to be shipped abroad to do voluntary service overseas. That is absolute rubbish. It has always been the case that some British junior doctors have chosen to go abroad at some stage in their training to get extra experience to further that training. Some do voluntary work in, or are on secondment in, the developing world—an issue on which the noble Lord Crisp recently produced an excellent report. However, there is no question of junior doctors being forced into those options or being shipped abroad.
	We all need to focus on the interviews that are taking place and that will continue over the coming month, the first round of job offers that will then be made, and the enormous effort that will go in—thanks to the work not just of the review group, but of consultants and the postgraduate deaneries around the country—to matching, as far as is possible, junior doctors with their first preference application, and to match, wherever possible, medical couples with their combined preferences through the medical training application system, which is an issue that was specifically raised. Of course, there will then be a second round of interviews and job offers. Once all that has been done, we will then ensure proper support, as I indicated a moment ago, for those trainee doctors who have not secured the training post that they wanted.

Rob Marris: I am very grateful to my right hon. Friend for patiently explaining the issues and for being generous in giving way. She talks about focus, and what I am focusing on is the figures that she has given this afternoon, which I have perhaps misunderstood. She mentioned 23,000 training opportunities and 32,000 applicants. I am focusing not on the MTAS system—good or bad as it may be in terms of the computer system and the lack of CVs—but on the fact that apparently and entirely predictably, 9,000 doctors, whom it costs £250,000 a throw to train and who have been in the system for a minimum of six years, will be redundant. That will be a great loss to the taxpayer, to the NHS and to them personally.

Patricia Hewitt: I am afraid that on that point my hon. Friend is absolutely wrong. Well in excess of 9,000 of those 30,000 applicants working in the NHS are working in non-training jobs that the service will continue to need. They are the so-called "trust" jobs—the service jobs—but they also include some of the senior house officer jobs, which are not training posts, despite their name. Those jobs, as well as the 23,000 training places, will continue to be needed and to be filled by junior doctors. That is why the headlines about 10,000 unemployed or redundant doctors are simply wrong.

Frank Field: rose—

Patricia Hewitt: I give way a second time to my right hon. Friend.

Frank Field: I am very grateful for the chance to make a second intervention. I ask my right hon. Friend not to answer the Liberal Democrats' endless plea for a post mortem.  [Interruption.] Yes, the Liberal Democrats did ask for a post mortem to find out what went wrong. We all know that something has gone wrong—even the Liberal Democrats should understand that simple point—but young doctors in Birkenhead want to focus on the future. In answer to my previous intervention, my right hon. Friend said that, at some stage, she and others would consider the creation of new training posts. Will she please say a word or two about that before the end of the debate?

Patricia Hewitt: I did indeed say that as part of sorting out the difficulties that have arisen this year we are already working with the royal colleges, the NHS and postgraduate deaneries to see whether additional training posts can be made available to start, of course, alongside the other ones later this year. We are looking at that issue.

Evan Harris: Will the Secretary of State give way?

Patricia Hewitt: No. I am not going to take further interventions, as I am very conscious of the time.
	We are also looking at what additional training and support should be given to those who take the non-training posts—the staff jobs and so on—so that they can continue their development. In some cases, they will be in a position to apply successfully for a training post next year.
	We are doing two things. First, through Professor Douglas' review and with the close involvement of the medical royal colleges, the BMA and other bodies, we are sorting out the problems that have arisen this year. Secondly, we are looking further into the future. As I announced last week, we are to set up a wider review of the modernising medical careers programme. It will be led by Sir John Tooke, and the House will know that I published the review's full terms of reference today.
	The principal task facing Sir John and his review group will be to examine the framework and processes underlying modernising medical careers to inform improvements for 2008 and beyond. Therefore, the existing group led by Professor Douglas will continue to make sure that we sort out the difficulties for this year, and Sir John Tooke's review will look ahead to next year.
	As hon. Members will see from its terms of reference, Sir John Tooke's review will look at questions such as whether the system is flexible enough—one of the main principles of modernising medical careers—or whether the scoring system devised through a very full consultation with the professions is now, on reflection, thought to be inappropriate and in need of revision. I am extremely grateful to Sir John for undertaking the review, and I stress once again that it will be completely independent. Sir John is identifying the members of his review panel and I shall make an announcement about that with him in due course. He will recruit his own secretariat and have a budget for that purpose. He has kindly offered to produce an interim report in September, as that will assist us in planning and making improvements for next year. That interim report will be published, of course, and Sir John has also undertaken to inform us of preliminary findings earlier. I know that Sir John will do everything that needs to be done to involve junior doctors, the medical profession more broadly and the NHS in the review. I have full confidence in him, and I hope that that confidence is shared across the House.
	As I noted earlier in this important debate, we have more than 30,000 more doctors in the NHS than we had 10 years ago. We have more trainees and more training places than ever before. We are establishing a new training system that will build on the excellence that British doctors have always achieved. However, it will also give us a much better, fit-for-purpose medical training system.
	We are sorting out the problems that have arisen this year, and we are learning lessons to ensure that we can make further changes and improvements next year. It would have been much better, of course, if the problems with this year's transitional year had not arisen. We all regret—I most of all—that they have arisen, but the new system that we are putting in place with modernising medical careers will be fair to doctors and right for the NHS. Above all, it will be best for patients.
	I commend the amendment to the House.

Norman Lamb: I want to start by speaking about the Government amendment that the Secretary of State has asked the House to support. It is remarkable for the fact that it makes no reference at all to the extent of the shambles in the medical training system. I assume that the amendment will win the day this evening, but anyone reading it would not have any understanding of the scale of the discontent in the medical profession resulting from what has happened.
	All those involved are left in a state of some despair, because the problem was so avoidable and because the damage that has been done—and the likely disruption still to be faced—have had such a negative impact on the NHS and the morale of the doctors on whom we all rely. Today, the Secretary of State repeated her apology to junior doctors. She was right to do so, because of the stress and anxiety caused to so many young professionals who have committed themselves to the NHS.
	Although the impact has been most severe on junior doctors, who feel that their careers are hanging in the balance, consultants too have been left completely frustrated and angered by the utter incompetence that they now have to remedy. They are faced with having to try to clear up the mess by undertaking a vast number of extra interviews in a short space of time.
	Of greatest concern, however, is the impact on patients. When doctors have rock-bottom morale, it is not good news for patients. What about the impact on patient care of the recovery programme—all the extra interviews that must take place during May? What will happen on 1 August? I shall return to those questions.
	How on earth did we reach this point? The origins date back to the chief medical officer's report in 2002. Its original principles clearly attracted widespread support. Self-evidently, there is a need for a modernised and focused career structure for trainee doctors. More standardised training based on competencies is the right way forward, and it is entirely reasonable to focus both on clinical skills and on the communication skills that I readily acknowledge are important for doctors. There were also legitimate concerns about patronage and bias in the old system. In any modern service those features are unacceptable and need to be challenged. Career advancement should always be based on merit, not on who a person knows or even the colour of their skin. I suspect that that has been a problem in the health service in the past.
	What went wrong? The Royal College of Physicians points to two failures. The first was that modernising medical careers had become a straitjacket. It was too inflexible: it forced early career decisions on young doctors and from that point demanded a training schedule that gave them little opportunity to change direction to a different specialty. It shortened the training period, leaving many doctors concerned that their experience would be reduced as they went through the training process.
	The second failure was the introduction of the medical training application service—MTAS—which was set up by the Department of Health to select junior doctors for MMC training posts. The royal college described the system as "deeply flawed, and unpiloted"—it had specifically requested that the system be piloted. Many concerns have been raised about how the unpiloted system has worked. It seems remarkable that so much emphasis appears to be placed on creative writing skills—we have heard about the number of points allocated for that competency—compared with clinical excellence. It seems that doctors who have undertaken research to prepare for a specialism could be disadvantaged. No CVs are considered and there is no proper acknowledgement of academic qualifications. The central question that the Minister of State, the hon. Member for Leigh (Andy Burnham), must answer when he responds is: how on earth did that happen? Is not it incredible that an entirely new, sophisticated web-based system was introduced without proper piloting?

Anne Milton: As the taxpayer is likely to have to fund the reviews of the debacle and its repercussions, does the hon. Gentleman agree that it is important that we hear from the Secretary of State or another Minister exactly who was responsible? We have not yet been told.

Norman Lamb: I am grateful to the hon. Lady for that intervention. I disagree with the right hon. Member for Birkenhead (Mr. Field), who seems to think that establishing who was responsible is a pointless exercise: it is essential if we are to hold the Government to account and learn lessons for the future. The hon. Lady made a point about the costs of the recovery exercise. I put that question to the Secretary of State during her statement last week. I did not get an answer, so I would be grateful if the Minister of State could confirm what assessment has been made of the likely additional cost of the recovery exercise.
	I was making a point about piloting. The terms of reference of the review highlight several features of the system. They include the assessment methodologies used in the selection process, including the relative merits of competency-based and more traditional methods of selection and recruitment; the level of choice on offer at application; and the lack of flexibility available to trainees on run-through programmes. They are all issues that would emerge from pilot programmes and the problems would be ironed out before a programme was rolled out nationally. How on earth was the system introduced without proper piloting?

Justine Greening: The hon. Gentleman is making some excellent points. Before I became an MP, I spent many years working in business and I cannot ever remember any company of any importance introducing an IT system without a full pilot and assessment of it afterwards.

Norman Lamb: The hon. Lady is absolutely right. Much smaller organisations pilot new programmes before they are introduced. We are talking about a system that is supposed to deal with tens of thousands of applicants across the whole country. It is bizarre and extraordinary that it was not piloted.
	Warnings also went unheeded. The Royal College of Physicians warned but was ignored. The British Medical Association said that it tried to get the Government to listen, but it was ignored. During the Secretary of State's statement last week, the hon. Member for Wolverhampton, South-West (Rob Marris) told the House that he had written several weeks ago to one of the Ministers at the Department—

Rob Marris: In the autumn.

Norman Lamb: The hon. Gentleman wrote in the autumn. He did not say to which Minister he wrote, but he said that he had not received a reply and that he had raised concerns about the introduction of the system. His warnings went unheeded.

Rob Marris: rose—

Norman Lamb: As I understand it, the hon. Gentleman has still not had a reply. Perhaps he is going to tell us otherwise.

Rob Marris: May I clarify the position for the hon. Gentleman? I wrote last autumn expressing concern about the system and I was assured by the then Health Minister, Lord Warner, that it would be all right on the night. When it became apparent in the spring that it was not all right on the night, I wrote and asked who was being disciplined on account of this failure. After many weeks, I have still not received a reply to that question other than the answer that I received from the Secretary of State in the statement last week, when she said that no one had been disciplined.

Norman Lamb: I am grateful to the hon. Gentleman for that. Even if no one is disciplined, people could still be held to account for what has happened, but we have had no indication of whether that will happen.
	Given that there was no piloting and that all the warnings from professional bodies were ignored, one is left with the sense that the Government have demonstrated total arrogance and total incompetence, or a pretty potent mix of the two. Who is responsible for the debacle? Will anyone be held to account? Surely, it is a pretty damning indictment when the former national director of MMC, Professor Alan Crockard, resigned stating that MTAS
	"has lacked clear leadership from the top for a very long time".
	What does he mean by "from the top"?

Gwyneth Dunwoody: We have heard a fairly solid dose of hypocrisy about this issue in some parts of the debate. No one is suggesting that we return to the absolute chaos of the previous system, in which some doctors suffered considerably. However, may I point out to the hon. Gentleman that Professor Crockard was presumably in on the arrangement from the first and was also acting as a consultant?

Norman Lamb: I am grateful for that intervention, but I made the point that the principles of the system were widely supported at the start and I highlighted the concerns about the previous system.  [ Interruption. ] I did highlight the concerns about bias and so forth; it was absolutely right to bring in a new system. It is the way in which it has been implemented that has caused so many people to be left totally frustrated by the Government's incompetence. Professor Alan Crockard may be partly responsible for the debacle, but when he says that there has been a clear lack of leadership
	"from the top for a very long time",
	we ought to listen to that concern.

John Leech: Surely the difference is that the professor has fallen on his sword, whereas the Secretary of State has not?

Norman Lamb: I take that point. When the professor says that there is a lack of leadership from the top, we need to know whether he is referring to the Secretary of State, or a civil servant —[ Interruption. ] MTAS is a Department of Health initiative, so we need to know from the Minister to whom Alan Crockford—[Hon. Members: "Crockard."] We need to know to whom Alan Crockard refers when he says that there is a lack of leadership from the top. Will the Secretary of State publish all the correspondence as part of a wider review so that lessons can be learned about what has gone wrong?
	Will the Secretary of State publish any written submissions made by Professor Shelley Heard, who has also resigned? Professor Heard was the national clinical adviser and has been quoted as saying that the principles
	"have been lost in the detail and acrimony of a recruitment process which should have supported and not driven it".
	She said:
	"we are losing the goodwill of a generation of UK graduates who believed it when we said we wanted to train more UK doctors better and we are losing the goodwill of patients and senior colleagues".
	Professor Heard also fundamentally challenged the direction taken by the review group set up by the Secretary of State. She said that the group
	"has become so immersed in the detail that it cannot see a way ahead which will be both equitable to doctors and support the aims of MMC".
	She found herself
	"able to support few of the decisions that the review group has taken since they undermine the principles which are at the core of MMC".
	Does the Minister accept that the review group's direction of travel is undermining the principles at the core of MMC, as Shelley Heard suggests? That is a serious challenge to the direction that the Government are taking.
	I am an employment lawyer by training, and before I became a Member of Parliament I advised employers on fair recruitment processes fairly regularly. This is not a fair recruitment process. It is fatally flawed, and once a process is flawed, one cannot satisfactorily remedy it. Will the Minister confirm whether the additional interviews for those candidates not hitherto given interviews will be conducted by differently constituted panels? However objective a scoring system, once different assessors are introduced on to a panel, objectivity is destroyed. Once something is flawed, it is always flawed, and that is why I have supported the attempts by Remedy UK to secure a judicial review of the process.
	I want to explore the recovery process itself. I understand that all the additional interviews will take place over a four-week period in May. Will the Minister confirm how many extra interviews the Government expect will be required? Will that be logistically possible to achieve? When I put that question to the Secretary of State last week, she said that it would be achievable, but "only with considerable effort". That suggests that there is a risk of substantial disruption to patient services and a possible impact on patients.
	I understand that trusts are resistant to allowing consultants time off their clinical work to conduct the interviews. The hospital trusts are all under intense pressure to deliver on waiting time targets, yet they will lose a substantial number of clinical hours to conduct additional interviews. I understand that 10 candidates were originally interviewed for two specialty training level 3—ST3—posts in cardiac surgery in London, but that it is expected that an additional 50 applicants will be interviewed to comply with the review group's new process. Will the targets with which acute hospitals must comply be adjusted to take account of the disruption that will inevitably occur, given that if a surgeon is interviewing, he or she is not operating? A question was raised about the cost of the recovery programme, and I hope that the Minister will give a confirmation of its cost.
	What analysis has been undertaken of the impact of all junior doctors starting their new roles on 1 August? The Secretary of State, who I notice has disappeared from the Chamber, indicated that the turnaround had always taken place on 1 August, but I understand from my hon. Friend the Member for Oxford, West and Abingdon (Dr. Harris) and many others that that is not the case. It was a phased process; all junior doctors across the country did not change jobs on one day. It is hard to imagine a more crass arrangement than one in which everyone is expected to start work under a new system at exactly the same time. Induction procedures will take doctors away from their duties, and I understand that many hospitals will, in effect, operate bank holiday working arrangements during that period, cancelling operations and clinics. Newly appointed doctors will find that their predecessors have already gone, leaving inadequate knowledge of the patients on the wards for whom the new doctors are supposed to be caring.
	I suppose that it was inevitable that the changeover for the whole country would be planned for a peak holiday time, when so many consultants are away. That simply adds to the challenge. I have heard that some trusts are starting to suspend the right of consultants to go on holiday in the first two weeks of August. That suggests that acute trusts are anxious about the potential impact on patient care during that period.
	On the mismatch between the number of applicants and the number of posts advertised, the Secretary of State indicated that there were about 23,000 training posts, but of those 23,000, she said that 3,000 were general practitioner posts. She then said that the net figure for hospital posts was something over 19,000. I do not quite understand the maths, but that is what she said. She also said that 700 extra posts were being added. I do not understand where that figure comes from, and I would be grateful if the Minister of State could explain when he winds up the debate. Are those 700 extra posts the additional training jobs that the Government said that they hoped to provide, or are we expecting more training posts on top of that 700? The people affected by the problem, many of whom are in the Gallery today, deserve clarity and answers from the Government on that point.
	The Secretary of State was right to point out that some, but not all, of the people who do not get training jobs will continue in their existing posts. Will the Minister give his assessment of the number of junior doctors who are likely to be unemployed come the summer? The hon. Member for Wolverhampton, South-West had a stab at providing a figure, but he was told by the Secretary of State that he had overstated the numbers because many people would remain in their jobs, so what is the figure? We know from the document leaked last week that Government planning is proceeding on the basis that thousands may be unemployed. It is incumbent on the Government to tell us the estimated number of junior doctors who will be unemployed this summer.
	The document referred to the possibility of junior doctors being sent off with Voluntary Service Overseas. VSO is a fantastic concept and I applaud all the junior doctors and the many other professionals who do voluntary work overseas, but as a human resources solution for a Government who have got themselves into a hole, it is hardly an appropriate way forward. Will the Government publish the document that was leaked last week? I have not seen it. Is it available, and may we see what the Government are planning to do with all the unemployed doctors this summer?
	We are told that it costs about £250,000 to train a junior hospital doctor. How many are likely to end up heading overseas or leaving the profession as a result of the crisis? What is the scale of the resources that will be wasted on all that training?
	The hon. Member for Wolverhampton, South-West raised the issue of the two cohorts coming together, as did my hon. Friend the Member for Somerton and Frome (Mr. Heath) in an intervention on the Secretary of State. We still have not had a satisfactory answer on why the Government did not expect that to happen and why they do not appear to have planned for it or its consequences.
	I suspect that the right hon. Member for Birkenhead might disagree on this point, but one sensitive, but important, issue is the way in which we treat foreign doctors who work in hospitals across the country, many of whom have given dedicated service to the NHS. How will they be treated as a result of this debacle? My hon. Friend the Member for Oxford, West and Abingdon made the point that, historically, staff grades that are often filled by ethnic minorities and women are, in a sense, dead-end jobs, with no prospect of career advancement. Why can the Government not plan to convert those jobs into training posts, to give the occupants the chance of career enhancements?

Evan Harris: Does the Minister accept that the key to the mismatch between the number of juniors looking for training posts and the number of training posts available is the question of consultant expansion? It begins and ends with that, because what patients want—we must remember patients—is a consultant-provided service. The Minister must explain whether medical schools were expanded in order to fill an expanded consultant grade, or whether they were expanded in order to fill trust grades, clinical fellowships and staff grades—all non-training posts, which many people do not want to occupy even though they are in such posts? Does he expect that the consultant expansion we need will take place? In 1997, a  British Medical Journal editorial noted that "consultant expansion was insufficient". That editorial was written by a Dr. Evan Harris, but 10 years on, I see that there is still no expansion—

Mr. Deputy Speaker: Order. I think that that doctor's intervention is long enough.

Norman Lamb: It has never been known in the past, Mr. Deputy Speaker. I endorse the question that my hon. Friend put to the Minister and hope that he will be able to respond.
	In conclusion, the scale of incompetence is quite remarkable. We need belated recognition from the Government that the problems this year have not been resolved and that the system remains fatally flawed. Remedy UK is seeking judicial review this week and I hope that it succeeds in that challenge to the Government, because the process, as we have all said, is fatally flawed.

John Gummer: Will the hon. Gentleman add to his questions to the Government a question about how bad the next disaster has to be before any Minister thinks that they ought to resign, so that we have a picture in advance?

Norman Lamb: I have a great deal of sympathy with the right hon. Gentleman's intervention. We heard earlier that the departing director said that the system had been mismanaged and that there had been a lack of direction "from the top". Where is the top? Is it Ministers? The Secretary of State has left the Chamber, as we have heard, but who will take responsibility? That is the critical issue. I fundamentally disagree with the right hon. Member for Birkenhead. If we are to hold the Government to account, it is right to find out what has gone wrong, who was responsible for it, and for that person to be held to account.

David Heath: On a point of order, Mr. Deputy Speaker. Is it not customary in the House for a right hon. or hon. Member who has made a contribution to remain in the Chamber long enough at least to hear the subsequent contribution from another hon. Member? Is that still the normal practice in the House, and does it apply to Secretaries of State?

John Gummer: Further to that point of order, Mr. Deputy Speaker. Is it not true that the Speaker recently circulated a note on that very point, not just to Back-Bench Members but to all Members, saying that it was courteous to listen to the following two speeches after making a contribution?

Mr. Deputy Speaker: The first point of order and the subsequent point of order are both accurate reflections of the Speaker's views about how Members should behave in the House. It is not the Chair's responsibility as to whether Ministers remain for the debates.

John Mann: I am sure that there will not be any hon. Members who wish to leave the Chamber until they have had the benefit of hearing my contribution. No doubt those who do so will want to read it in the morning.
	I wish to begin by declaring two interests. Of course, my family and I are users of the national health service, which we use, and will continue to use, exclusively. I am an unpaid member, too, of the editorial board of  People Management, which is the leading human resources management magazine in the country.
	I make the point because I note that there are two young and keenly engaged Ministers on the Front Bench. In the political traditions of this country, one of the problems faced by all Governments is that Ministers change so rapidly. That has always been the case. I have never fully understood the logic whereby successive Governments of all kinds have chosen to keep changing Ministers rapidly, with Ministers moving between different portfolios. That creates a potential problem for Ministers when they inherit the results of the actions of previous Ministers, in addition to the problem of mastering the brief. The point is not specific to the debate today. It applies to the technical issues that arise in attempting to hold the Government to account.
	My suggestion to the Government and anyone else who cares to read  Hansard tomorrow is that one of the big opportunities missed in the past 10 years, as it has been by successive Governments, and which I hope a change in Prime Minister will grasp, is that Ministers ought to be trained through, for example, the Henley Management college in effective leadership skills to equip them for the management of major Government Departments. This may be the only chance I have to put that on the record before a change of Prime Minister. It is an idea that I have held and discussed with Cranfield School of Management, Henley Management college and others. It is relevant to all parties. How we manage major Departments is fundamental to the effectiveness of Government.
	My second observation is how comforting it is to have such a feeling of déjà vu with respect to union organisation and strength, and the solidarity of the closed shop. It is many years since I have witnessed such good union organisation. There are rumblings outside the House—only just outside—in traditional union style, and traditional union briefings. Traditional closed shop arguments have been accepted by the Government.
	That takes me back to the time when I tried to negotiate for young engineering apprentices who were doing four years of training but were not guaranteed employment by engineering companies at the end of it. How jealous we were of Fleet street, where there was an age-old tradition of a trade being passed from father to son, apprentices being guaranteed work, and jobs for life. The changes that took place in the mid-1980s were bitterly resented by those families and particularly by the young workers, who perceived entry to that trade as a vocation for life. I see some resonance with the Government's acceptance of the arguments and their guarantees of employment for junior doctors.

Michael Penning: With regard to Ministers moving on too fast, the Secretary of State has been in office throughout this debacle—since the general election. If she is not up to the job, surely the senior management, the Prime Minister, should sack her.

John Mann: There is another game going on, and that is called the knock, knocking of the NHS. The Opposition's motivation in having this debate, and the style of debating used, has been to knock the NHS and run it down, rather than look at the specific technical issues and how they may be improved, as the Liberal Democrats rather more realistically have attempted to do. The party that never really loved the NHS in the first place has a political agenda.
	On every occasion the Opposition attempt to suggest that the NHS is in great crisis. The best judges of that are the patients, and my area is as good a judge of the state of the NHS as anywhere else. Since I have been a Member of Parliament, the NHS in my area as been a top performer. Two years after I became an MP it became the top performer in Britain, and remains so.
	The hon. Member for North-West Norfolk (Mr. Bellingham) is no longer in his place but he referred to incompetent NHS local management. That is not what I see. In my regular meetings with management, consultants and GPs, one of whom I met to discuss some of these issues at length last week, I hear pertinent points about where they wish to see improvements, but there is pride in the fact that modern management, modern doctors and modern GPs now receive the funding that they deserve and have the tools to do the job. That is a fundamental difference from the past.
	I shall illustrate that with one of the campaigns that I ran. [ Interruption.] The hon. Member for Hemel Hempstead (Mike Penning) from a sedentary position asked what I had had to do with improving the performance of the NHS. Along with thousands of my constituents, I have made a tiny contribution. When there was not a Government but a management move to downgrade my accident and emergency department, I led the campaign—

Mr. Deputy Speaker: Order. This is not a debate about the training of Ministers or the NHS in general; it is about modernising medical careers.

John Mann: That is precisely the point that I am leading into. The successful ballot on the accident and emergency department in my hospital was caused for only one reason, and that was that there was a perceived problem in recruiting consultants to cover that department. The issues raised in my hospital and by my GPs are the problems of attempting to recruit both specialists and generalists in a semi-rural area with a district general hospital and GP practices—

Justine Greening: rose—

John Mann: I will give way in a minute, but it is important that I make this point because it is precisely on the issue of modernising medical careers in areas that have been underfunded, traditionally and historically, and which because of that have had recruitment problems for many years. The shift in allocation is one of the bravest things that the Government have done. The 11.5 per cent. increase in PCT funding last month was the biggest in the north of England— [Interruption.] This is absolutely on the subject. The subject is how my area can recruit the consultants and the GPs that it needs, and how, in an area such as Cresswell, just outside my constituency in the constituency of my hon. Friend the Member for Bolsover (Mr. Skinner), where many of my constituents worked for year upon year, the NHS had not been able to recruit GPs until last week, when a new GP practice was appointed.

Justine Greening: I am obviously listening to the hon. Gentleman's rather long speech with interest. I presume that it is long because so few of his own Back Benchers are present to stand up for the junior doctors who face this terrible crisis. I am wondering whether he will ever start talking about the subject of the debate, which is about the junior doctors throughout the country who face redundancy having gone through an horrific recruitment process yet who still do not have an answer from the Secretary of State about what will happen next.

John Mann: The hon. Lady is choosing not to listen to the point that is being made. The question of recruitment is fundamental to the changes that are taking place in modernising medical careers. What is the point of having large numbers of junior doctors if there are not jobs? I drew an analogy with the closed shop. Many professions would like that certainty of employment in following their careers but do not get it. Equally, what if a hospital such as mine cannot get the consultants it requires to cover accident and emergency and questions whether it should have A and E, or if an area such as Cresswell does not have enough GPs? In the wider area of Warsop, which incorporates Mansfield, there have repeatedly been problems in getting enough GPs to cover the work that is there.

Fraser Kemp: Some years ago, we had a serious problem in the city that I represent, Sunderland—we had the lowest proportion of GPs anywhere in the UK. When we investigated, we found that in many cases, because of the funding arrangements, doctors themselves were not encouraging recruitment into practices. The health authority intervened to deal with the situation, but it was not the fault of the Government or the money going in—doctors themselves were not going out of their way to recruit more doctors in our city.

John Mann: My hon. Friend makes an excellent point.
	Let me ask a couple of questions of Ministers. Under the Government's plans, how will areas such as mine be guaranteed the consultants whom a small district general hospital requires in order to maintain core services by having staff in place and who come from the ranks of junior doctors? How will that be done, and how does it fit into the Government's planning in the longer term?

Andrew Pelling: Will the hon. Gentleman give way?

John Mann: No; I am going to conclude in a minute because many Members wish to speak.  [ Interruption . ] No doubt that includes the rude hon. Member for Hemel Hempstead, who is saying, "Thank goodness."
	How can we ensure that an area such as mine, which has top-performing NHS services and where we have moved from small one-man-band GPs to large GP practices, can get the quality of GPs to meet the new kinds of specialties that the Government rightly want to devolve down to primary care from the hospital sector? How does that fit into the vexed question of junior doctors wanting to follow traditional forms of careers when some of the new specialties that are required are in primary care, not in the hospitals sector—an issue which official Opposition Members, as is clear from their barracking, have no desire to debate.

Peter Viggers: I congratulate the hon. Member for Bassetlaw (John Mann), who made a clever job of distracting attention from the profound concern that is felt in much of the House.
	We are facing the worst and most avoidable disaster to overtake young people in professional training. Thousands of young people are being plunged into uncertainty about their careers. The tragedy is that this disaster was predictable and predicted—it is unfolding like a slow-motion train crash. I am grateful for the opportunity to be able to contribute briefly on behalf of my constituents, who feel anger and disbelief about the present situation.
	The people involved in this disaster are mainly professionals. Of no professionals is so much asked, in terms of resilience and commitment, as doctors. When doctors commit to the profession of medicine, an enormous amount is asked of them as regards training, and there is an assumption that at the end of their training period they will eventually have an opportunity to work and that that will be reflected in a fulfilled sense of commitment.
	There is a need for change in doctors' training and most people agree that it was appropriate to make a change. However, in their manner of doing that, the Government are at fault not only in the detail but in the larger issues. They have been greatly at fault in three main matters: administration, computer failure leading to mismatches occurring, and the number of jobs.
	The Secretary of State provided several facts when trying to explain the position. I submit that those facts did not help me—and I followed her contribution carefully—to understand the position better. Apparently, there are to be 23,000 training posts and 32,000 doctors are seeking them. However, she gave us many other numbers, seeking to lead us to believe that there was no problem.
	I am afraid that there is a problem, because the Government have failed to deal with the double cohort—the two different groups of doctors who will enter training in August. Some will work under the previous system and others will work under the new system.
	The Secretary of State failed to provide assurance in the case of an individual doctor in my constituency, whose mother I met today. The doctor is 28 years old, has been qualified for six years and has always wanted to specialise in intensive care. She was offered a post in August last year. It was a two-year post in anaesthetics, which would lead her to qualify in anaesthetics or go further and use her anaesthetics qualification to specialise in intensive care. Now the two-year post that she was offered in August 2006 has collapsed, leaving her with the prospect of no medical job after August this year. She is not simply a highly qualified doctor but someone who, with one other woman, rowed the Atlantic as part of her gap year.
	Doctors must be given a guarantee that they will not be forced out of training. A formula must be found to permit their training to continue. The Government need to take exceptional measures and give us progress reports. The matter must be resolved by August—if necessary, by using interim measures.

David Kidney: The county town of Stafford employs a high proportion of public sector workers because it is an administrative centre. There are workers in local government, the hospitals, the university and so on. That means that, when a problem arises in the public sector—be it last year's efforts, which were especially bitter in Stafford, to try to deal with deficits in health trusts, or junior doctors this year struggling to find a training post and feeling that they have been badly treated—it affects not only those who work in a hospital trust or another health setting, but a large proportion of the public because of their affinity with the public sector generally. That might apply to the Member of Parliament who has such an affinity because of political values, the workers because they work in the public sector, and the public, who come into contact with public services perhaps more than in other areas because of Stafford's higher than normal proportion of jobs in the public sector.
	The subject of the debate is therefore generally a serious issue for Stafford. I am happy to explain that that is one of the reasons for my participation this afternoon. However, people obviously want to bring the debate to the personal level. In preparation for last week's return to Parliament and the Secretary of State's statement and today's debate, I met the junior doctors' leader in Stafford, local NHS managers and local providers of health education. Like many hon. Members, I have also met a junior doctor from my constituency who lobbied me about his personal circumstances, and representatives of the campaign that Remedy UK has organised for today. I am pleased to have an opportunity to take part in the debate to support the points that they made to me.
	It is worth starting from the point of view expressed in the original words of the motion. What has been extraordinary about the history of medical training in this country is that it suffered its share of severe underfunding for decades before 1997, which led to a shortage of training places. That led, in turn, to a shortage of qualified doctors, consultants and nurses in the NHS, which created quite a challenge for the new Government, who were committed to improving the situation very quickly. Although the Government could turn on the tap for more money to pay for more doctors, nurses and consultants, there were not enough of them to recruit because the training places had been cut for years before. That is an important point for hon. Members to take into account about the history of how we came to be in the present situation.
	The obvious corollary at the time was that because the money was made available and the posts were there to be filled, we recruited outside the country to fill the vacant posts. That is relevant because while people talk about the double cohort of people coming through to training posts now and the senior house officers also looking for a training post, we also have the added pressure of non-EU citizens in this country whom we recruited who still want jobs in the NHS. There was something of a failed attempt by the Government last year to squeeze them out. That in itself was hurtful to quite a large number of my constituents who came from the Indian subcontinent in order to work in this country because we needed them. All those points should be taken into account when we reflect on the situation today.
	It is a good thing, is it not, that more people are in training, completing it and coming forward in greater numbers? It is also a good thing that recruitment and retention generally in the NHS has been good over the past few years. I hesitate to say that it is good now, because I am not reading a Labour party brief and want to tell it as it is. Obviously, the Government's insistence on getting rid of deep-seated deficits, which started last year—an insistence, incidentally, that I support wholeheartedly—has led to a crash in recruitment and retention. That provides a further additional pressure—on top of the three that I have already identified—when it comes to the training places available for junior doctors now. It is easy to add them up and see that four pressures have all come to bear this year on the problem of the number of places available for the junior doctors who are seeking them.
	The review body, comprising all the bodies that the Secretary of State described, and then Ministers, took the decision that this year is the year in which modernising medical careers for junior doctors should kick in. It is certainly a difficult year. In the looking back that the hon. Member for North Norfolk (Norman Lamb) called for, and in seeking attributions of blame for the current situation, a good question to pursue would be whether there was any opportunity to hold back from making it this year. However, it is fair to say that modernising medical careers is the right thing to do and has gained widespread support.
	It is remarkable that no one in today's debate has asked to turn back the clock and go back to the previous system. Every hon. Member has spoken about how MMC could have been introduced more effectively and how it should be improved in future years. In some areas of recruitment—before it was applied to junior doctors—it has been implemented without the sort of reaction that we are talking about today. General practitioners two years ago provide a good example of that.
	When I met the leader of the Stafford junior doctors, she drew my attention to certain issues that I strongly support. First, for example, it is right to standardise training standards for junior doctors seeking specialty posts. It is also probably right in this day and age for there to be an online system. It reminds me of my adult son and daughter who use the internet, rather than pen and paper, as second nature when it comes to compiling a CV for a job application. Those aspects are right and are here to stay.
	Other points that we have discussed today, however, included the scoring system, the lack of flexibility, the people who did not get acknowledgements for their online applications and felt that the applications were never read, and the doctors who felt forced to apply for jobs at the other end of the country from their families. All those personal circumstances, which I discussed with the leader of Stafford's junior doctors, were individual tragedies.

Norman Lamb: The hon. Gentleman is making some fair points in criticising the way in which the system has operated. Are not all the features that he has described evidence and justification for the need for such a system to be piloted before being introduced?

David Kidney: I agree with the hon. Gentleman. I considered whether to intervene on him earlier to say that I agreed with him on that point, but I also intend to say in my speech that developments such as these should be piloted in future. So the answer to his question is yes.
	I was describing the personal tragedies that have happened because of the way in which the system has been introduced. I want to remind hon. Members who were not here eight days ago when the Secretary of State made her statement to the House that, on that occasion, I made the point that this concerns individuals who each demand more respect from the system—and the people administering it—than they have been getting over the past few months.
	In fairness to the Secretary of State, she has apologised at least three times for what has gone wrong with the system and for the distress that that has caused to those affected. One review has proposed changes that are about to be introduced, and she has also announced a further, broader review, which has been mentioned today. The shadow Secretary of State made a temperate speech today, with many good points. One of them was about the independence of that review, and the importance of all of us having confidence in its deliberations and conclusions. That is an important point for the House to make.
	Meanwhile, making a success of the first review, with its guarantee that every junior doctor who applies for a post and states their first preference will have at least one interview, is placing a terrific strain on managers and consultants to deal with the extra work that they are being asked to do over the short space of time between now and August. It is fair to say that they are the hidden heroes who are solving this problem right now, and they deserve our thanks. The hon. Member for North Norfolk made that point earlier. A number of consultants wrote a letter to  The Times earlier this month to say that they had been placed under a lot of pressure, at a time when they had plenty of other work to do to meet the demands of patients and the NHS. We owe them a debt of gratitude. That letter, incidentally, also called for the scrapping of MTAS and a return to the previous system, so although I said that no one in this debate had asked for that to happen, other people certainly have. We should remind ourselves, however, that the previous system had serious faults too. It did not find a specialty training place for every junior doctor either.
	If the Minister listens to the shadow Secretary of State, and to my hon. Friends who have said the same thing, he will realise that there is the prospect of a win-win situation. My hon. Friend the Member for Bassetlaw (John Mann) made the point that certain areas are short-served by the NHS at the moment, and we could create a win-win situation by expanding the number of training places available for junior doctors in those areas and in specialties where there are shortages. Perhaps those shortages exist because people do not want to take on those specialties, and it would be wrong to force anyone to do something that they did not want to do, but this could give us an opportunity to ask people to look again at specialties where there are shortages, in which they might be able to do a good job. We could create a win-win situation by filling the posts that we need to fill and finding places for the people who want them. I hope that the Minister will be able to respond to that point later.
	I want to put forward some points on behalf of a doctor in my constituency with whom I have had a good, spirited correspondence on his concerns about modernising medical careers. He and I agree that we are unsure about the evidence on the number of available posts and the number of people applying for them. Obviously, the more transparent Ministers can be about this, the better it will be for people who have fears—whether politically motivated or not—about what is happening. It is clear, however, that there are fewer training places than there are people applying for them.
	My doctor correspondent makes the point about the double cohort, observing that
	"increased numbers of medical students are passing through their second foundation year and needing specialist training. The shortened training also has a big impact on the large number of senior house officers who also need to find a place on the new training pathway."
	The two cohorts are coming together at the same time. He also makes the point that non-EU doctors are competing for those posts. He concludes:
	"The new doctors in their second foundation training year have no chance of success against the more experienced senior house officers and the non EU graduates."
	I do not know that, and I bet that most people in the House today do not know it, because we are not sure whether we have enough confidence in the system to say whether that is the case. The doctor goes on to say that
	"MTAS has had to make its mark by designing an application form in which experience counts for virtually nothing. Selection is largely from the psychology questions which have no tested validity in this field. The marking of these questions is also widely variable between different markers."
	All those factors have undermined confidence in the system so far.
	I shall not name the doctor without his permission, but it is important to get his views on record. His letter goes on:
	"I should tell you that this whole exercise has also been an opportunity for government to reduce the 'power' of doctors and their representative bodies."
	Such allegations can be made, and can sound reasonable, because of the mess that we are in at the moment.
	There has always been competition for posts, and some people will always find themselves in short-term posts because they cannot get the specialty training that they want. I was pleased to hear the Secretary of State say that support will be available for such people after this year, but will my hon. Friend the Minister tell me more about their prospects in future years? Can they always expect to be treading water and becoming what some people call the second lost tribe, or will they have the prospect of moving on? It is in the context of their fear that they will have nowhere to go that we hear the constant talk of people being forced to emigrate to find a job.
	I shall return to the effect that all this is having on my constituents. It is demoralising for them to hear that the state is paying to train bright young people to provide a service that everyone wants and values, only to see them emigrate because they cannot be given a post in their own country. That is very harmful.

John Leech: Does the hon. Gentleman acknowledge that some doctors will be left without a job, or does he agree with the Secretary of State, who seems to think that there will be a job for everyone?

David Kidney: The hon. Gentleman cannot have been listening to what I have said. Under the previous system, not everyone got the specialty post that they applied for, so they did something else. They still had a job, however. The Secretary of State has said that nothing in the new system will change that basic fact. If someone does not get a specialty training place, they will still have a job. That is the point of my question to the Minister. What are the prospects for those people who still have a job, even though it is not the training post that they want? That is a reasonable question.
	I mentioned earlier that a university in Stafford offers health training. Admittedly, it does not train junior doctors, so I will not push my luck too far in talking about issues other than modernising medical careers. I want to make the point, however, that there have been superb improvements in medical training in recent years. There have been some great developments, from foundation degrees to professional doctorates. In terms of continuing professional development, relationships between NHS employers and training providers have been much improved, including the excellent development of mentors for newly qualified doctors and other health professionals. Much better recognised training and qualifications have been developed for those in the support teams for doctors and consultants. For example, last week, at Staffordshire university, I heard about training for operating theatre staff, the pilot for primary care staff, and the current deliberations about whether help can be provided in the training of care home staff. We should celebrate all those excellent developments.
	Everyone I listed at the beginning of my contribution has said that better work force planning is needed. Nobody would disagree with that. We are dealing with one of the biggest work forces in the world, not just in the country, so it is understandable if it presents more difficulty than others. Clearly, good work force planning involves listening and research, engaging those who know what is happening and have expertise to offer, piloting changes before implementing them more widely, on which I agreed with the hon. Member for North Norfolk, and, having carried out pilots, conducting proper evaluation before the final implementation. If there are lessons to be learned from today, I hope that the Minister will accept that those points cover some of them.

Nadine Dorries: I thank Remedy UK and the junior doctors for the lobby that they organised in a professional and effective way. You were not in the Chair, Mr. Deputy Speaker, when the Public Gallery erupted, rather naughtily, into spontaneous applause earlier. They managed to do something that Opposition Members rarely achieve, no matter how many hours we debate for: to make Government Members hang their heads in shame—

Mr. Deputy Speaker: Order. I am sorry to interrupt the hon. Lady in full flow, but it is customary not to refer to anything happening outside the Chamber.

Nadine Dorries: I apologise, Mr. Deputy Speaker.
	There are 650 MPs in the House, and I do not know how many of us have three As at A-level. I would imagine, however, that the number is in single figures. Junior doctors have had to plan from childhood to become doctors—deciding that they want to do so when they do their GCSEs and choose their A-levels—because it is incredibly hard to get the results necessary to go into medical training and pursue the career with determination for six or seven years.
	The Opposition have agreed that medical careers needed to be modernised, because the system did not work as it did in the past. As a nurse, I know that. What doctors did not need, however, was a computer system that failed hopelessly and abysmally, application dates for interviews extended by days, data lost and the computer system crashing. Junior doctors did not know what was happening to their applications, when or where—or if—their interviews were being held, or whether they would have a training position.
	Nor did junior doctors need uncertainty, particularly those who have families or are dependent on their jobs or salaries, as we all are. We are all dependent on knowing how much we will earn this year, particularly if we have a mortgage to pay. Thousands of junior doctors do not even know whether they will be able to make their mortgage payments, let alone whether they will be able to pay any debts that they may have brought with them out of university or medical school, or whether they will be living in a particular area with their families or working in a particular region.

Justine Greening: My hon. Friend is making some excellent points. Anyone with primary school-age children is possibly going through the process now of working out which primary school they will be starting in September.

Nadine Dorries: I thank my hon. Friend.
	Although we are not allowed to refer to what is happening outside the Chamber, I can legitimately bring some of the comments made by junior doctors to the House's attention. There has been much speculation about how many doctors will not have jobs, and the figure seems to range between 9,000 and 11,000, so we can safely say that it will be about 10,000. We know that the Department of Health is in discussion with VSO about finding employment for our junior doctors, which is a shameful position for the fifth largest employer in the world to be in.

Michael Penning: I could not agree more with my hon. Friend. Will not that just delay the problems, because once doctors have done the wonderful work that they can do with VSO, they will come back to the country and have no jobs?

Nadine Dorries: Absolutely. The majority will come back and look for jobs, and we will be faced with the problem later.
	Moreover, were I a junior doctor, I might not want to go and work for VSO. I might want to stay in this country. I might have a family and a mortgage, and might want to continue my career in the UK. Dr. Sonia Heyer, of Harrow, Middlesex, said:
	"As a junior doctor who may be unemployed this summer as a result of the present recruitment fiasco, I was delighted to learn that we may be required to seek employment with voluntary services overseas.
	I would go, provided I could secure the company of the present Secretary of State for Health, in which case I would gladly accept a mapless mission to the Amazon jungle."
	She is a braver woman than I—I would not want to go with the Secretary of State for Health. Junior doctors, however, are facing no employment during the summer, or perhaps going to work abroad with VSO, which is not what they want.
	The Secretary of State has largely chosen to ignore the problem that she knew, as my hon. Friend the Member for Gosport (Peter Viggers) described, was a train wreck in slow motion. As the Chancellor was warned of the pensions fiasco, I am sure that the Secretary of State was warned of what would happen with a double cohort. Another doctor, Dr. Judith Secker, described the process as follows:
	"It was the equivalent of taking a decision for all children to leave school at the age of 17 instead of 18. In the year when the change came into effect, all the 17-year-olds and all the 18-year-olds would be seeking university places (or employment)"
	at the same time. We all know that that would be a complete shambles, and that is what we are faced with today.
	I am sure that the Secretary of State was warned about what was going to happen, but what was put in place to deal with it? Absolutely nothing. We have two cohorts of junior doctors looking for placements all at the same time, which has caused unnecessary competitiveness between them, indecisiveness, uncertainty and worry. One doctor, a junior orthopaedic surgeon, has said that three junior doctors in the past two months have burst into tears on his ward because they do not know whether they will have a job from 1 August.
	The fact is that our doctors do not know whether they will be earning a salary. If they do not want to work for VSO, where will they go? A junior doctor in my constituency, as a midwife in my constituency has done, has applied for summer work at Waitrose. That doctor has done seven years' training and 12 months in a hospital. What kind of Government tell our junior doctors to spend their summers working in Waitrose?
	I do not want to take up too much time, and I want to allow other Members to speak, but I have some questions that I want to ask the Secretary of State. Will she let us know what will happen to the 10,000 doctors who will not be in employment? Will they be offered compensation? Will they be found work somewhere other than abroad? Will she leave 10,000 doctors without jobs? We need an answer. What will happen to those doctors? If they are unemployed, she will hear a lot more about it. Actually, I am not so sure about that, because the matter will come to fruition and hit the headlines in August, and I am sure that she will not be in her current position by that date.

Andrew Pelling: I greatly enjoyed the engaging speech of the hon. Member for Bassetlaw (John Mann), who stressed the importance of proper allocation of public resources. However, it cannot constitute the best application of public resources to spend a quarter of a million pounds on the training of every junior doctor, and then to face the prospect of so many leaving the country to be employed elsewhere in the English-speaking world.
	This afternoon I met four junior doctors, all of whom have had job offers within a very short period—in Brisbane, Singapore and Toronto. Almost all are at the specialist training stage, and they could be described as emblematic of the problems created by MMC. Often those who have made the most progress in their training are most affected. It is a great shame to see £1 million of investment and training going elsewhere, as I did when I met those doctors today. The hon. Member for Bassetlaw would think it a great shame as well if he recognised that this misallocation of resources will make it difficult for his constituents' needs to be met.

Fraser Kemp: The hon. Gentleman has rightly raised the allocation of public resources. Many innovative health authorities, including those in my area, are paying GPs salaries rather than giving money to their practices and giving doctors a quasi-self-employed status. Does the hon. Gentleman support the move towards salaried GPs?

Andrew Pelling: It is certainly worthy of debate, but I want to concentrate on the Secretary of State's approach and what it means to my constituents who came here today. Apparently they will have jobs in the NHS, but not necessarily in their particular specialties. It is rather like telling a promising young libel lawyer that he or she can have a job as a conveyancing solicitor. What those doctors heard from the Secretary of State today was not about jobs for GPs; she seemed to be saying that they might as well emigrate, and with great immediacy take the training jobs that are being offered to them elsewhere in the English-speaking world.
	I have seen the Department's leaked document revealing the desperate measures that will be taken to try to find jobs for doctors somewhere in the NHS. The suggestion that somehow jobs can be found in accordance with the model in the highlands and islands of Scotland shows how desperate the situation has become for the Government. Junior doctors cannot retain much confidence in the system when—as my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) pointed out—they see such a demonstration of the arbitrary nature of the selection process. I know of a consultant who had to deal with 650 applications in four hours. The 150 that were not dealt with went straight into round two.
	As others have said today, a large number of applicants are not sure whether their applications were even considered. They cannot judge whether they were rejected on grounds of merit or whether their applications were simply neglected. Many junior doctors will look at the MMC site, which states boldly:
	"Progress through each stage of training will be through open and fair competition using nationally standardised application forms and guidelines."
	However, the oblique standardised forms that replace CVs mean that junior doctors can have no confidence that they have been able to give full expression to their talents or suitability for a post.

Justine Greening: Is it not bizarre that that is probably the only recruitment website in the world that does not allow applicants to attach CVs to their applications?

Andrew Pelling: Notwithstanding the bold statement that the process is fair, it can only mean that people who have invested not only years of training, but before that many years securing the necessary qualifications to begin that training, are being given a most unreasonable deal. I would not be at all surprised if the junior doctors whom I met today said, "This is the last straw," and took up those job offers abroad, which are better than anything that the NHS can provide.
	The new system involves a great deal of uncertainty. Others have spoken of the danger of court action. There are questions to be asked about the quality of the curricula to be provided, and also about the standing of the medical training that our country provides. That standing is important not only to junior doctors but to the United Kingdom as a whole, but the "gold standard" is in danger of being compromised.
	It is always difficult for politicians to recognise that they have made mistakes, and we are grateful that the Secretary of State has been able to apologise. However, as the hon. Member for Bassetlaw observed, it takes leadership to be able to recognise that it is time to cut one's losses. If junior doctors are to be given the confidence that will enable them to stay in this country, they must be offered the prospect of jobs in the NHS through the provision of training jobs in the first place. If we are not to lose a quarter of a million pounds' worth of training for all the junior doctors who will depart these shores within the next few months, we must accept what the Opposition motion says. Jobs—training jobs—must be given to people who have invested so much of their time to become junior doctors and serve the people of this country.

Richard Taylor: The disaster that threatens to derail MMC is the medical training application service, so I shall concentrate on that.
	It seems that whatever topic is raised, it is possible to choose witnesses and evidence. The briefing from NHS Employers glosses over all the difficulties. The date of 1 August has always been a nightmare, because junior house officers have always changed over on that date. The fact that senior house officers and registrars did not do so in the past has made it slightly easier, but I fear that there will now be a disaster. NHS Employers says:
	"Employers are working with their consultants and junior doctors now to ensure that services for patients are not adversely affected by the change in timing. This is vital as employers need to be confident that well qualified doctors are in place to deliver safe and high quality patient care from August 1 when the new training programmes are available."
	Sadly, as the House knows, there are no junior doctors in training in my patch, but as one of the few ex-hospital doctors in the House I have had a great many letters from such doctors. To obtain an accurate assessment of the position outside, I wrote to  Hospital Doctor asking for comments from senior consultants involved in training. I invited comments in support of MTAS and comments in condemnation of it. I received exactly 40 letters: one expressing support, one expressing qualified support and the remaining 38 expressing tremendous worry. These are not whingeing letters from consultants. In contrast to the opinion of many Members, consultants work very hard for their patients, and the relationship between a consultant and his junior staff was—I hope that it still is in some ways—that of a father and their family. I remember consultants whom I worked for who were father figures, and I hope that I, too, was such a figure to my juniors. Therefore, I take seriously the comments of consultants.
	I cannot express those comments except by reading some quotations, so I have selected brief passages from four of the letters, which I want the Minister to hear. A correspondent from the north-east wrote:
	"It is almost beyond belief that the MTAS online application form, which ignored qualifications and previous experience and relied on answers to fatuous questions, was introduced nationally without validation or piloting. Widespread scepticism and concern was expressed by a large majority of colleagues who attended MMC Recruitment and Selection Training courses with us, which was ignored."
	Comments from Aberdeen include:
	"I have personally witnessed the devastating effects this process has had and is having on our highly trained junior doctors"
	and
	"I have personally seen weak candidates being offered 4 interviews and very strong, able candidates being offered only one."
	A correspondent from Cambridge wrote:
	"If the madness continues, then in August there will be many unfilled junior hospital jobs and many junior doctors without jobs...this will be dangerous for patients...and the effect on junior doctors cannot be overestimated."
	I also received the following:
	"We will have contrived a situation where many English trained graduates leave the country and we import doctors to fill the places."
	The writer of the letter goes on to say that if he were allowed to do so he could easily fill the jobs by August.
	Finally, a letter from Northampton states:
	"I have been dismayed by the unfolding disaster that is the Medical Training Application Process. I have discussed these problems with many senior and junior colleagues and know that their views are much the same as mine",
	and
	"We have let down all these young doctors, as well as damaging the present and future health care of patients. Equally important we have lost our reputation for medical training. This is true nationally and abroad. I have just returned from a trip to Malaysia where I spoke to doctors, university educators and other professionals and the common views expressed were amazement at how the UK got itself into this mess and secondly that they would no longer consider it wise to send their bright young people to the UK to train in medicine."
	Other problems include the stupidities in the scoring system—such as applicants getting two points for having a PhD and four points for their 150-word description of their personal qualities. There are also problems to do with the time involved for consultants drawing up the shortlists, let alone interviewing, and the fact that the interviewers do not know whether applicants have put their institution as their first choice. Also, to interview all applicants who put a particular training option first would be impossible without cancelling clinics and operations. The knock-on effect on spouses and families has been referred to; such families will now face uncertainty, and there might be splits between partners and between parents. The short time that is available to relocate is also a problem, as are the costs to the NHS of relocating.
	What should we do in the future? Many of my correspondents feel that there is only one thing to do: to abolish MTAS. A professor of surgery writes:
	"Although some of our leaders are still trying to find a compromise...the bare minimum to restore confidence in our medical students and junior trainees would be disbanding PMETB and MTAS."
	Readers of  The Guardian will this week be relishing some of the most famous 20th-century speeches. Nelson Mandela has been cited, and a few words from a speech he made in 1964 are worth quoting:
	"I regard the British parliament as the most democratic institution in the world".
	I hope that the House will listen to the voice of grass-roots hospital doctors, and realise that when something is deeply unfair and wrong there is not a compromise to be had, and that instead there must be a restart.

Justine Greening: I am pleased to be able to contribute to the debate because, like other Members, I have received many letters from constituents, many of whom are directly involved in the process or who have brothers or sisters or more distant relatives who are directly involved in it. Many of them have been extremely concerned about what has happened. I wish to take this opportunity briefly to express some of their concerns in their own words.
	Many described the process that they have been through as "shambolic". One said that, essentially, it was like a "creative writing exercise", and wrote of his colleagues:
	"One wonders why they bothered to commit so much time and energy to a profession to have their ambitions potentially shattered in a flawed process. Many of our junior doctors at my hospital are in a worse position and have no interviews and nothing to hope for at all."
	Another correspondent says that the online application form is "riddled with error" and that the
	"process is spectacularly breaking down".
	She described the form as:
	"A series of 8 tree-hugging questions with 150 word answers"
	and that that
	"replaced any common sense when it came to qualifications, aptitude, and professionalism in order to assess the candidate. Any idiot could have answered those questions well."
	Clearly, we do not want idiots to take up such important positions.
	Other people talk about the system crashing when they tried to fill in their applications. One described their first interview, which was in Manchester on 16 March:
	"I took along my portfolio and my cv and offered to show it to the interview panel and they told me that it would not be necessary."
	How can we expect good recruitment decisions to be taken when CVs are not even looked at? Another person who got in touch with me was a candidate in a Birmingham interview session which was cancelled at the last minute. Another described the system as a
	"vastly unfair, harsh, draconian punitive selection procedure"
	that has been imposed
	"on all junior doctors within the UK. Lives are being destroyed as we speak and the UK will lose its brightest and best doctors of a generation if it is not stopped."
	Those are the kinds of impact that the system that we are debating has had on junior doctors.
	Many relatives are equally concerned. A father got in touch with me about his daughter. He describes the situation as
	"nothing short of a disgrace. The future loyalty to the NHS of these young people on whom we shall depend will have been lost. They have absolutely no confidence that they will be fairly treated now or in the future."
	Many Members have been made aware of similar cases involving people who had spent many years training to become doctors and who had almost got to the final hurdle only to find that it had been taken away; they were not even allowed to jump over it at the beginning of this unfolding shambles. The situation is depressing. Getting the Government to take action has been like pulling teeth—to use a medical simile. Over a period of several months, the Minister and the Secretary of State have had to come back to the House to continue to explain what is happening in respect of this unfolding disaster.
	One clear way that we can tackle this matter and give some genuine confidence to the junior doctors who are listening to the debate, and to those who will read about it tomorrow in  Hansard, is to vote for the motion before the House. That will give them the confidence that the necessary training posts will be in place over the next few years to help us work through this crisis in a measured way, which is what we need to do.
	I want to ask the Secretary of State about the Tooke review. It is obviously easier—and, given the judgment calls already made by the Department, more appropriate—to get out of this mess by subcontracting it out to Sir John Tooke. However, in her opening speech the Secretary of State said that Sir John might make recommendations to the House earlier than August if he considers it appropriate to do so. Why is that not her decision? Surely it is appropriate for junior doctors to know much sooner what is going to be done about this problem, rather than having to wait until the end of the summer. By that time, many will have already taken alternative decisions about their careers. People cannot just put their lives on hold until this Government manage to talk their way out of this shambles.
	I have another question for the Secretary of State and for the ministerial team who have been involved in this process. What will happen if Sir John Tooke's review uncovers further problems, if the shambles develops in an even more dramatic way and, as my hon. Friends have suggested, we get to August and many junior doctors are left redundant? What will it take for the Secretary of State to say that enough is enough regarding her and her team's role, and to take voluntary redundancy, which many people in her Department have done? Whose career prospects are being damaged more—the Secretary of State's, or those of the many junior doctors who will not get a second bite of the cherry, once they have lived through this shambles?
	This is not good enough, and it certainly is not the best year ever for the NHS and the doctors whom we have been discussing today. The NHS has been fundamentally financially mismanaged in the past decade. As an accountant, I was astonished to see financial boom in the NHS followed by bust. Such boom and bust is largely responsible for the destabilisation of recruitment in the NHS—an issue far broader than the catastrophe that MTAS has created. How many more shambles have to occur before the Secretary of State takes genuine responsibility, instead of continually subcontracting Government policy out to other people and putting off taking decisions?
	The situation is urgent for those involved; they have not got until August to wait for answers. If the motion before the House is accepted, that would at least provide them with some certainty about their roles and what will happen in the coming years. It would give us the chance to take a thorough look at what has gone wrong, and to consider in detail what needs to be done. As I have said before, as someone who has been in business I know that when many different issues unravel over time one needs to take a step back and to look at the fundamentals of what is going wrong. However, our junior doctors cannot wait for an holistic review process. We need to give them some certainty by voting for the motion before us.
	Having read this debate in tomorrow's  Hansard, not many people will have much confidence in this Government and their ability to deliver and work their way through these dramatic problems. It is not just doctors who are concerned about the recruitment process. I have no doubt that many nurses throughout the country who are finishing their training courses will be shuddering at the prospect of the process that they will have to go through to find a job over the summer months. It is not good enough to be told that we are having a review, and that there will be no answers before August.
	The Secretary of State referred in her opening speech to creating some additional training posts. It is incumbent on her to give the House a sense tonight of the number of such posts. What is the approximate number? What is too low, and what is unrealistically high? That is what we and junior doctors need to know. I doubt whether many of us have much confidence in the management team at the very top of the Department of Health. Frankly, the sooner that that team is changed and we have people who can run professionally an organisation that so many of us depend on—whether we work in it or are treated by it—the better.

Andrew Murrison: We have had an excellent debate this afternoon, involving a total of seven Back-Bench speakers, all of whom contributed, in their own way, to our deliberations.
	I start by declaring my interest as a registered medical practitioner, although mercifully I am not one of those caught up directly in the shambles that we have been discussing, or one of those involved in events outside this place today. A number of us went outside to speak to the representatives of Remedy UK and to listen to what they had to say. I recommend that Ministers listen to what they have to say to them, too, because they have done a wonderful job in highlighting this issue to Members.
	An NHS consultant whose daughter is a junior doctor emailed yesterday to say:
	"The whole concept of MMC had some merit but the way it has been planned and carried out is nothing short of scandalous."
	That is a pretty good way of epitomising what many of us feel about this issue. The hon. Member for Wyre Forest (Dr. Taylor) gave a series of worrying accounts in a similar vein from other consultants throughout the country. My hon. Friend the Member for Putney (Justine Greening) gave further evidence from junior doctors who had written to her with personal stories of how this catastrophe has affected them in a direct way. In her excellent contribution, she was right to ask—as a number of other Members did—that the second, Tooke, review be truly independent. That means that when Sir John Tooke chooses his team, its membership should not include those previously involved in this process, because they would inevitably bring to the debate preconceived ideas. It is important that this issue be approached with fresh eyes.
	We Conservatives have always supported the evolution of a consultant-led, increasingly consultant-delivered service, and we support the principles of MMC that underpin it. We can, of course, debate points of detail such as the removal of the influence of the medical royal colleges and their replacement by the expensive training quango PMETB in 2005. It is salutary to remember that those are the same UK royal colleges whose supervision of medical education and training was described by the Health Secretary on 16 April as "second to none".
	However, having agreed with the Government in principle, we turn to implementation. At the heart of this, of course, lies MTAS. As he threw in the towel as MMC's national director, Professor Alan Crockard said that MTAS
	"has lacked clear leadership from the top for a very long time."
	Others have used that quotation and I make no apology for repeating it. We have to ask what he meant by "the top"; I leave Ministers to draw their own conclusions. Professor Shelly Heard was similarly scathing as she quit as MMC national clinical adviser.
	The courageous hon. Member for Wolverhampton, South-West (Rob Marris), in a thoughtful intervention on the Health Secretary on 16 April, asked who would be held to account for the debacle that we are examining today. She replied in her trademark, rather breezy fashion:
	"As far as I am aware, no disciplinary or performance management steps are being taken in the Department, but no doubt that can be considered as appropriate."—[ Official Report, 16 April 2007; Vol. 459, c. 48.]
	So nobody has taken the rap for what doctors have described as the biggest crisis to hit British medicine since the start of the NHS.
	The hon. Member for Bassetlaw (John Mann) suggested that Ministers should avail themselves of the services of the Cranfield or Henley school of management. Of course, those schools teach leadership, which is what is needed now. Next, my hon. Friend the Member for Gosport (Peter Viggers) underscored the seriousness of the crisis. He asked that Ministers give the House regular situation reports as the reviews go on. That is important, given the enormity of the problems facing the NHS.
	Much of MMC and MTAS has been designed to remove the influence of the old boy network—I suppose that one can call it that—that Ministers believe has been responsible for the appointment of junior doctors in the past. NHS Employers is a metastasis of the Government's cheerleader, the NHS Confederation. In its briefing note, it identifies the twin crimes of "patronage" and "bias" in the appointment of junior doctors. In its zeal for reform, it does not pause to consider at what terrible cost those sins have been purged. Many will believe that the Health Secretary's surgery has been somewhat worse than the disease.
	Apart from the drearily predictable NHS Confederation, there have been remarkably few apologists for the mess over which the Health Secretary has presided. Let us set aside for a moment the administration of MTAS, which has caused so much heartache, and focus on modernising medical careers. We can applaud the intention to move forward to a more focused, competency-based training that reflects what has been happening in other trades and professions, and in other countries. We hope that training will be more flexible and, as women make up half the medical work force, that it will facilitate a better work-life balance. It is surely right that doctors are better able to communicate with patients and colleagues, and that communication is a key element in any training or assessment process. Modernising medical careers recognises that, but we have grown an inflexible monster that forces early job choices on young doctors that will be difficult to move out of and into. Practical experience will be curtailed and all of a sudden that "second to none" training about which the Health Secretary boasted in her speech last week is beginning to look far less robust.
	MTAS is truly remarkable. In place of a CV and hard data encapsulating hard-won academic qualifications and clinical experience, applicants are invited to furnish a load of soft mush. Other hon. Members have mentioned scoring, and the hon. Member for Stafford (Mr. Kidney) referred to that. The essential concern is that the influence of PhDs, for example, has, as we discussed earlier, been eclipsed by offerings in essay form that are made up at short notice and in a way that, as my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) noted, is capable of being imparted in a course that costs very little.
	Certainly, the current system encourages creative writing and theatricality. No doubt they are invaluable attributes, but they are hardly core competencies for aspiring consultants—even, if I may say so, for consultant surgeons. I understand from a written answer sent to me on 13 March that MTAS will cost £6.3 million over five years. Can the Minister who will wind up the debate confirm that that does not include the cost of the paraphernalia of failure—review groups, appeals, judicial reviews and so on? I assume that it does not, because last week the Health Secretary admitted that she did not know how much the review that she had announced would cost.
	On 16 April, the Health Secretary said of the extra resources required by the first—the Douglas—review that
	"the service around the country will in many cases need to release consultants from their planned activities in order to make time available for the additional interviews."—[ Official Report, 16 April 2007; Vol. 459, c. 45.]
	What assessment has the Minister made of the cost in front-line patient care caused by the crisis? What will be the impact in the next few weeks of the redeployment of medical staff apparently necessary to patch up MTAS? How many operating lists will be cancelled, how many clinics scratched, and how many ward rounds foregone?
	The hon. Member for North Norfolk (Norman Lamb) is worried about logistics, costs and wastefulness, and rightly so. I am delighted that the Liberal Democrats will support our motion this evening.
	On 19 March, the Health Secretary said that
	"shroud-waving about unemployed doctors is absurd"—[ Official Report, 19 March 2007; Vol. 458, c. 582.]
	On 16 April, we had more assurances from the Secretary of State when she said that she wanted to take
	"the opportunity to refer to the thoroughly misleading statements made in recent weeks about the prospect of thousands of junior doctors finding themselves without work. This is complete nonsense."—[ Official Report, 16 April 2007; Vol. 459, c. 46.]

Patricia Hewitt: indicated assent.

Andrew Murrison: The Health Secretary is nodding. In contrast, however, NHS Employers has at least some grip on reality. We learn from its leaked report of how it is desperately scratching around for jobs abroad to offer doctors who it recognises will be unemployed on 1 August. The NHS Employers briefing paper talks optimistically of service posts that have been converted by employers into training posts. How many of those have there been after Lord Warner's announcement of 13 December, and how many more does the Minister anticipate? Other hon. Members have made that point already, and it is important that we know the numbers involved.
	While NHS Employers has been trawling the world to see where it can park unemployed British doctors, has it asked our EU neighbours how they might help? Given that many of the available training billets in the UK will be going to European economic area doctors, it seems reasonable to ask where the reciprocity is. The right hon. Member for Birkenhead (Mr. Field) spoke about banning European doctors, and that point may be germane here. Certainly, we recognise that the treaty obligations into which we entered—rightly or wrongly—forbid us from banning European doctors. That is simply not possible, but NHS Employers might consider Europe as it trawls around the world. Many Labour Members have been greatly exercised in the past by unpaid researchers attached to MPs' staff. In a like manner, are they not concerned that officials are entertaining a scheme to hive unemployed junior doctors off into voluntary service overseas? What would be the precise terms of such an arrangement?
	Heaven for junior doctors will be a place on a run-through training programme. The Government are saying, "Get that and you're well on your way to consultant status, in due course. Fail and you're set for a grisly series of fixed-term specialist training appointments, so-called locum appointments for training, a re-run of your second foundation year"—how depressing must that be?—"Undefined academic appointments of the sort we thought MMC was designed to address, professional 'locuming' and a constellation of low-grade, non-training jobs. You'll be part of your postgraduate dean's euphemistically styled 'talent pool', to be fished out when something vaguely suitable turns up."
	I hope that that "something suitable" does not involve working in a supermarket, as happened to the constituent of my hon. Friend the Member for Mid-Bedfordshire (Mrs. Dorries). The lost tribe of senior house officers is set to become nomadic as they drift from hopeless job to hopeless job with little chance of breaking out, in stark contrast to the previous flawed, but far less rigid, milieu. It is little wonder that so many dedicated, expensively skilled professionals are set to quit the UK and the NHS, as my hon. Friend the Member for Croydon, Central (Mr. Pelling) pointed out, and even to quit medicine altogether.
	The Health Secretary's fulsome apology last week was indeed appropriate, but junior doctors facing the prospect of being hung out to dry want to know why she is not joining them.

Andy Burnham: The hon. Member for Westbury (Dr. Murrison) is right to say that this has been a good debate, and I shall do my best in the time available to answer some of the points that have been raised.
	This matter is of fundamental importance to the country. We must ensure that patients get the best possible care from highly trained and motivated staff, but we recognise that there has been a significant impact on the lives and careers of those dedicated and hard-working staff who are applying to progress their training as doctors in the NHS. Young people and their families will be watching today's proceedings closely, and we know that they will have gone through considerable anxiety. I know from the e-mails that I have received—and I am sure that other hon. Members of all parties have received similar messages—that there has been considerable anxiety about this matter. It is right for the Government to address that and to give people practical information so that we can map a way forward.
	My right hon. Friend the Secretary of State began by setting out the principle of modernising medical careers. One of the interesting things about today's debate was the degree of agreement on both sides of the House, expressed by almost every Member who spoke, about the principles behind MMC. The programme has the potential to benefit both doctors and patients in the NHS and it is important to note that its foundation stages have been successfully introduced. We believe that we can build on that success.
	The difference between us and some Opposition Members is that they suggest that all the measures were hatched in secrecy in the Department of Health and that we did not involve anybody else in drawing up plans for this stage of the implementation of the MMC programme. That is not the case. We have worked closely with the Academy of Royal Medical Colleges, the BMA, NHS Employers and others over a long period. However, we are not washing our hands of the issues. We have tried to face up to them, but the important thing is to take action now to help people and to put in train a wider review of the system so that when this year's process is over, we can ensure that lessons are learned and that, in time, we can bring in a strengthened system.
	The suggestion crept into many of the comments today that there were no unfairnesses or problems in the old way of doing things. That simply is not the case. If we accept the principles of MMC, we must also accept that there were myriad unfairnesses in the old system. The difference is that those unfairnesses were not out in the open, in the transparent way that they are now— [ Laughter. ] It is because they are transparent that we can work through the issues that have been identified and create a fairer training system for doctors.
	The hon. Member for North Norfolk (Norman Lamb) made a speech that was good in many ways. He, too, endorsed the principles of the programme and observed that patronage and bias had been problems in the past. Despite the laughter from the Conservative Benches, the hon. Gentleman was right to identify those problems. He suggested that the system was too inflexible—a point raised by the shadow Secretary of State in his opening remarks. I draw the attention of both Members to one of the points in Sir John Tooke's terms of reference:
	"the lack of flexibility available to trainees on run-through programmes".
	Sir John will examine that specific point in his review.
	The hon. Member for North Norfolk spoke about the lack of a pilot for the scheme. In fact, the electronic portal for foundation recruitment was piloted in 2006. The application form was based on an existing form used in the London area, and the current form was piloted pre-launch in at least two deaneries. At the end of the day, we can review the programme and consider whether there was enough piloting and I shall take on board the conclusions of the review. However, it is not the case that the scheme was rushed through with no attempt to consult or to pilot.
	The hon. Gentleman asked how many extra interviews would be required. Originally, 26,000 non-GP interviews were scheduled. The number of extra interviews required following the Douglas review will depend on how many junior doctors change their first preference. As the hon. Gentleman knows, that process has been going on over recent days so it is obviously too early to give him the figures. However, we estimate that guaranteeing one interview for each eligible applicant will require between 13,500 and 23,900 interviews. The number will depend on how many doctors change their preference. We shall of course need to balance the requirements of the service—another point made by the hon. Gentleman. We believe that the provision of extra interviews in round 1 is likely to reduce the number required in round 2, but we shall work through that issue as we go further down the line.
	We shall not know how much additional cost will be incurred until the end of the process. However, the proposals have been agreed with the deaneries and NHS Employers. We believe that is the right action to take, because it will bring back a degree of fairness and meet the complaints we faced—that the system was unfair and people were being denied opportunities. Like the hon. Member for Westbury, the hon. Member for North Norfolk asked about the provision of care to patients during the period of the review. We shall not relax any service standards or targets.
	The hon. Member for North Norfolk asked my right hon. Friend the Secretary of State about the 700 posts that are to be added. Originally, a small number of one-year posts was held over for round 2. After the review group's recommendation, those posts were loaded on to the system for the extended round 1, so the 700 posts will soon be available on the system. I hope that that answers his question.
	My hon. Friend the Member for Bassetlaw (John Mann) made an interesting point, which again goes back to the principles of the MMC programme. He asked about the needs of communities such as his, where traditionally there have been problems in the recruitment of both hospital-based staff and GPs. My area is in a similar position. My hon. Friend the Member for Houghton and Washington, East (Mr. Kemp) pointed out that in his area, too, there were real difficulties in recruiting more GPs. MMC is being introduced to ensure that we can address those recruitment problems, especially for shortages such as that of GPs in the north of England. In principle, the scheme enables people to move from over-subscribed to under-subscribed specialties and we believe that the review group's proposals for early announcement of recruitment for GP training will encourage applications in that field, which has traditionally been under-subscribed.
	The hon. Member for Gosport (Peter Viggers) asked about double cohorts and why we could not guarantee everybody a place. May I give him a snapshot of the situation? At present, about 3,000 senior house officers are training in surgical specialties, feeding into about 500 specialist training opportunities for surgery. It is the case, as it always has been, that not everybody can be a consultant surgeon. The difference is that under the old system people hung around trying to progress their careers, but could not obtain opportunities to do so.

Andrew Lansley: Will the Minister give way?

Andy Burnham: I have very little time and I want to do justice to the Members who spoke in the debate, if the hon. Gentleman will forgive me.
	Like other Members, the hon. Member for Gosport spoke about the double cohort—[Hon. Members: "Give way."] When I have answered the hon. Gentleman's point I will give way. There has never been any restriction on applications for sought-after training posts—it is not a feature of the new system. Indeed, I am sure that the hon. Gentleman would be the first to agree that it would be wrong if the Government imposed restrictions on people in staff grades applying for those posts, so I am not sure that he was raising a valid point.

Andrew Lansley: Our motion calls for SHOs who are not able to obtain entry to specialist training this year to have opportunities to do so next year and the year after. Will the Minister confirm that the Government will ensure that that is the case?

Andy Burnham: I was coming to that point, but first I wanted to do justice to the excellent and thoughtful speech made by my hon. Friend the Member for Stafford (Mr. Kidney), as well as to other points that were raised. The shadow Secretary of State makes an important point—that we must do what we can to ensure that help and support is available for doctors displaced this year. Of course, they will be able to apply in future rounds in future years, even if they are applying from a non-training or staff grade post.
	There is much more we can do this year. We are working with the service to maximise the number of job opportunities available in and leading up to the end of the 2007 recruitment round. We will invite any displaced doctors to register on NHS Jobs and NHS Professionals so that they can quickly and efficiently be matched to the vacancies that will continue to emerge, to training posts and to locum appointments, as was always the case. Posts will become available in any normal year.
	We will work with the postgraduate deaneries to maximise the number of training opportunities available within the overall number of job opportunities. In particular, we will undertake urgent work with the medical royal colleges and the service to establish the need for additional training posts. We will ensure that doctors who take up jobs in service grade posts continue to have support to ensure that the training and development opportunities in those posts are maximised. Those unsuccessful this year will be able to reapply next year. They will also be able to apply for posts that emerge, as they always have, through the course of the year. I am glad that the shadow Secretary of State raised that issue because I am pleased to put that point on the record.
	I fear that I cannot do justice to all the sensible points that were made in the debate in the time that I have left. I conclude by saying that we recognise the anxiety that this year's round has caused. We have not sought to dismiss it; we have sought to engage with it and come up with solutions to give people real answers to the difficulties in which they find themselves. Implementing quickly the recommendations of the review group will further help the position that people find themselves in and, crucially, will give support to people who have been displaced by the process and will help to enable them to progress their careers as they had hoped to do.
	I am grateful to colleagues for their contributions to the debate. I hope that we can agree a measure of consensus that will provide a good, workable training system for the NHS that will stand us in good stead for many years to come.
	 Question put, That the original words stand part of the Question:—
	 The House proceeded to a Division.

Mr. Deputy Speaker: I ask the Serjeant at Arms to investigate the delay in the Aye Lobby.

The House having divided: Ayes 213, Noes 284.

Question accordingly negatived.
	 Question, That the proposed words be there added,  put forthwith pursuant to Standing Order No. 31 (Questions on amendments), and agreed to.
	Mr. Deputy Speaker  forthwith declared the main Question, as amended, to be agreed to.
	 Resolved,
	That this House recognises the international reputation for excellence of medical training in the UK; acknowledges the need to modernise medical careers to ensure all doctors are properly trained to nationally recognised standards, including a fairer and more transparent process for applying for specialist training; notes that Modernising Medical Careers (MMC) will deliver training to a consistently high standard which, combined with the expansion of the number of doctors, will provide high quality safe care by appropriate skilled medical staff; notes the wide consultation that took place on MMC and the strong support for the need to improve doctors' training amongst doctors' representatives including the medical royal colleges and the British Medical Association; welcomes the external review that is already being conducted into how MMC has worked to date and the changes made as a result; and supports the longer term review recently announced to ensure MMC works well in the future.

Local Government

Mr. Deputy Speaker: I must inform the House that Mr. Speaker has selected the amendment in the name of the Prime Minister and that there will be a 10-minute limit on Back-Bench speeches in the debate. Will hon. Members who are not staying for the debate please leave the Chamber quickly and quietly?

Caroline Spelman: I beg to move,
	That this House notes that council tax has soared by 92 per cent. across England since 1997, with even higher increases in Wales due to the Government's council tax revaluation; notes with concern proposals in the Chancellor's town hall finances report for regular council tax revaluations, higher council tax bands and new taxes for the collection of household rubbish; observes that frontline services such as weekly rubbish collections, social services and libraries are under increasing pressure; and calls for local people to be given a greater say in the provision of local public services through democratically elected local government rather than unaccountable regional government.
	Just over a month has passed since Sir Michael Lyons published his report on local government finance. In the absence of Government time to debate its contents and implications for local government, I am pleased that we have that opportunity today.
	I agree with this much of the Government amendment: there has been a
	"transformation in local government since 1997".
	I put that down to the rise in the number of Conservative councillors from 4,550 in 1997 to 8,529 in 2007 and to the rise in the number of Conservative-controlled councils from just 24 in 1997 to 167 today. Had the amendment finished there, I would have been tempted to support it.

Phyllis Starkey: I note that the motion condemns changes to rubbish collections. However, no doubt the hon. Lady is aware that 61 Conservative-controlled councils have introduced fortnightly rubbish collections, presumably as a worthy attempt to increase recycling. Is she condemning them?

Caroline Spelman: I will come to that subject. However, I should share with the hon. Lady the fact that, unfortunately, we need to be careful about the information that the Government publish on that subject. A parliamentary answer that I received listing the councils that had moved to fortnightly collections cited a number of councils that have not done that, including King's Lynn and West Norfolk borough council and Ashford borough council, which have no plans to do so. She might like to talk to Government Departments about the accuracy of the information that they provide.
	I commend Sir Michael for the tenacity and rigour with which he carried out the review. There are elements of the report with which we strongly disagree, which I shall come to shortly, but I shall start with those aspects that we welcome.
	We welcome the recommendations for more transparency in the way in which Whitehall funds local government; that is something for which we have long been calling. Likewise, we have long supported giving communities the final say on the type of leadership structure that they have. It makes perfect sense to give local authorities greater involvement in health and well-being—indeed, some councils such as Kent county council already have that greater involvement.
	The main focus of Sir Michael's work was the thorny issue of local government finance. One of the first things he did was dismiss local income tax as a viable alternative. For me, the most telling line in the report is the one in which he said that a local income tax
	"might mean substantial increases in tax for the working population."
	He also set out why a local income tax would not necessarily be a fairer tax: it is because income is not always the sole determinant of wealth. Those are failings that Members of all parties have acknowledged, including the Liberal Democrats.
	It is a symptom of how controversial local government finance has become that the Government tried so hard for so long to bury the report. The review took nearly three years, had a wage bill of more than £300,000 and was subject to numerous changes in remit, but the final indignity was that the Chancellor tried to bury its publication on the day of the Budget. He wanted to bury the report because he knew that it would confirm people's worst fears about the tax-raising appetite of the Treasury.
	Surely Ministers know that there is real, palpable fury out there about the level of the council tax. No matter what Ministers say publicly, they know that responsibility for a 92 per cent. rise lies firmly at the door of the Treasury. People who paid just £57 each month on a band D property in 1997 are now paying £110. Taxation in any form is never popular, but if council tax was a mild irritation in 1997, it has become a gaping sore today.

Ian Austin: One of the local authorities controlled by the hon. Lady's party is Dudley metropolitan borough council, which serves part of the area that I represent. Dudley council has received record resources under the Labour Government and this year its settlement is above the average for metropolitan authorities, yet it is still increasing the council tax by 5 per cent. while cutting services. It is closing swimming baths and cutting services for the elderly; it is even cutting school transport for special needs schoolchildren. Is that what the Conservatives mean when they talk about the proceeds of growth? Will she condemn the record of Dudley council, which is receiving record resources and cutting services?

Caroline Spelman: It was hardly worth giving way for that rather lengthy intervention. If the hon. Gentleman waits, perhaps he will come to understand better just how many burdens have been placed on councils such as Dudley council and how shortfalls in NHS funding have put huge pressure on local councils. I shall address those points further later in my speech.
	It defies belief that the Government thought that the 92 per cent. rise in council tax would go unnoticed. Ironically, council tax is the most visible of all tax bills. It is not deducted automatically at the point of income or added automatically at the point of sale. It is worth noting that if council tax rises were commuted into income tax, it would be equivalent to a 4p rise.
	We now know that there are plenty of people who are prepared not to pay, and plenty more who simply cannot pay. The only solution that the Government offer those who cannot pay is an application form for so-called benefits. The application form is 40 pages of intrusive questions that actively deter a proud generation of pensioners who find the term "benefits" an indignity. As Sir Michael Lyons himself says,
	"The term benefit has a particular resonance, which may prevent some people from taking up their entitlements."
	In the words of Age Concern,
	"Council tax benefit is still the most unclaimed benefit of all, with up to 2.2 million older people missing out on up to £1.4bn each year".
	I am not cynical, but I do wonder whether it suits the Treasury to have such a low uptake. What a way to treat pensioners. Not only is the Chancellor complicit in the collapse of people's pensions, but a third of the increase in the state pension is now clawed back by the Treasury through increased council tax, yet instead of finding ways of reducing the tax burden, the Government are considering recovering council tax after people have died. A typical pensioner drawn into that macabre "pay later" scheme could leave a debt of as much as £64,000 after 20 years.
	Pensioners and people on fixed incomes are not the only ones suffering. Hard-working families all have to budget hard for a council tax bill that escalates every year. In fact, we are now so conditioned to accept inflation-busting rises that the Government congratulate themselves if rises of less than 5 per cent. are introduced.

Clive Betts: Is the hon. Lady's main complaint that the Government have not changed the council tax benefit system sufficiently since her party introduced it at the beginning of the 1990s? If so, what specific proposals does she have to reform the council tax benefit system to remove all the problems that she is talking about?

Caroline Spelman: I have been an MP for 10 years, and in all that time the hon. Gentleman's party has been in office. I have heard the Government say repeatedly that they want to improve council tax benefit and I have seen constant hand-wringing, yet I still see no real progress. The Age Concern figures confirm that. Sir Michael Lyons makes a good point: the very word "benefit" is off-putting. The hon. Gentleman's party, which is in government, commissioned that mighty report; it is for Government Ministers to answer the questions that he puts to me.
	I am dismayed that the Government's attitude is to portray a 5 per cent. tax increase as an achievement. That tells me that there is real poverty of ambition on the Government's part. An increase of what the Government would term a "mere" 5 per cent. is still a massive hike when we consider that the overall level of council tax has virtually doubled since 1997. Ministers' constant refrain is that it is all the fault of local government, but nobody believes that. If Ministers honestly believe that 92 per cent. rises are simply the result of profligate town halls, they must be in cloud cuckoo land. However, some councils are more prudent than others, and the statistics show that Conservative councils cost people less. On an average band D property, they cost £55 less than Labour councils, and £84 less than Liberal Democrat councils.
	The council tax has been abused, wasted and used to fill the Treasury's coffers. This year's Budget confirmed that receipts to the Treasury have risen by 114 per cent. since 1997, bringing the total tax take to £23.5 billion for 2007-08.

Tom Brake: Will the hon. Lady confirm that, before she finishes speaking, she will set out the Conservative alternative to the council tax?

Caroline Spelman: I had rather hoped that we might get an intelligent defence of Liberal Democrat tax plans from the hon. Gentleman. He clearly was not present on the occasions when we debated council tax and the aspects of it that need to be reformed. If he bides his time, he will find that I make a number of constructive suggestions later in my speech.
	The remaining council tax that is not drawn into the Treasury is used to fund the Deputy Prime Minister's largesse towards the unwanted regional agenda, to bankroll an inspection regime that has grown like Topsy since 1997 and to make up the shortfalls from NHS cuts. Is it any surprise that Sir Michael Lyons commented at the launch of his report that
	"council tax is not 'broken', but...has been put under too much pressure"?
	Against that backdrop, the House will understand why we want to debate the matter.

Phyllis Starkey: rose—

Caroline Spelman: I accepted an intervention from the hon. Lady at the beginning of my speech and, if she will bide her time, I shall come on to the question of refuse collection.
	The report contains a series of additional ways of taxing people that the Government have refused to rule out. The only option ruled out so far is the bed tax on British holiday makers, which will certainly please my hon. Friends the Members for Brentwood and Ongar (Mr. Pickles) and for East Devon (Mr. Swire), who campaigned against the proposal in our seaside resorts. That brings me on to the proposals that the Government have not ruled out, including the call for additional tax bands at the upper end and for changes to the ratio between the bands. In particular, appendix C models changes from the present 3:1 ratio to 5:1 and even 10:1. To put that in layman's terms, on a band D property, the bill would go up by as much as £119. That is the tip of the iceberg. Rebanding cannot take place without revaluation, and revaluation will mean that bills go up. That is exactly what happened in Wales. Despite assurances from Ministers that the revaluation would be revenue-neutral, four times as many homes moved up a band as went down, and the average bill went up by 10 per cent. in the first year.
	We fear that that would happen in England. No one is under any illusion about how expensive and intrusive revaluation is.  [ Interruption. ] Regardless of whether people own their home or rent it, they will be taxed on home improvements and the quality of their neighbourhood.  [ Interruption. ]

Mr. Deputy Speaker: Order. May I tell the Minister for Local Government that his turn will come?

Caroline Spelman: Thank you, Mr. Deputy Speaker. To make the situation worse, Sir Michael Lyons has recommended not just one revaluation but regular revaluations, so I wonder how many harassed husbands will have the perfect excuse never to do any DIY again. Every detail of people's homes is at risk of being photographed, catalogued and taxed. Anyone not complying with the inspections will face a fine of £500, which is totally unacceptable.
	People are left asking where all the money is going. I hear the constant refrain, "How can it cost so much to empty my bins?" The irony is that the Government are heavy-handing local authorities into cutting rubbish collections. Let us be quite clear: the Government have created a situation in which council tax bills have doubled and rubbish collection services have halved. The reality is that council tax pays for a great deal more than refuse collection, but it is illustrative of people's sense of unfairness. Crucially, council tax helps, too, to pay for social care, but it is in social care that the biggest and most frightening crisis is under way.
	John Dixon, vice-president of the Association of Directors of Adult Social Services told  Caring Times earlier this month:
	"This isn't a crisis waiting to happen, this is a crisis already here".
	The shortfall in social care this year is £1.8 billion. The impact of that shortfall is felt acutely by families caught between meeting the costs of bringing up children and paying the top-up fees for their parents' care. What a cruel position to put people in.

Chris Mole: The hon. Lady has described a rising demand for local government services, which have been met in recent years partly by the increased grant from central Government and partly by council tax, which explains some of the numbers to which she referred. How would she meet the costs of additional demand for social care, given that the shadow Chancellor has talked about cutting funding for a range of services and sharing the proceeds of growth?

Caroline Spelman: Apart from the fact that that shows a remarkable lack of understanding of the way in which many prudent Conservative councils have striven hard to maintain front-line services, notwithstanding central Government grant settlements which, in many cases, are inferior to those of councils controlled by other parties, the hon. Gentleman shows a marked lack of understanding about the kind of moral judgment that I have tried to make. I genuinely believe that the amount of money wasted on the whole unelected regional empire created by the Deputy Prime Minister would be much better spent on front-line services, particularly in adult social care.
	In the face of the crisis in local government funding, I used to think that the Government were guilty of standing idly by, but in fact, that is not true. The Government are actively making the situation worse. Two in three councils report that NHS cuts have had a direct impact on social care provision. While councils strain every sinew to make efficiency savings at the Government's request, to the tune of £220 million last year, the Government simply load them with more cost burdens, form filling and money-draining bureaucracy. The latest example is the Government's decision to embark on a round of costly and unpopular restructuring. Have the Government become so detached from reality that they think that restructuring should be a priority? If that is the case, frankly, Ministers ought to get out a bit more. Sir Michael Lyons was right to say:
	"Reorganisation is not, in most cases, likely to provide either a theoretical or practical solution to the challenges we face."
	That is the view of the man whom the Government commissioned to look into the future of local government. When I was canvassing for the local elections, no one spontaneously asked me for the restructuring of their local council.

Robert Key: Is my hon. Friend aware that my constituents hope that the Government's crazy proposals to go for a unitary structure of Wiltshire will be proved illegal? What really makes them angry, however, is the fact that there has been no consultation, no referendum, and no boundary review, given that the Boundary Commission did not request the change. It is, in fact, taking democracy away from local people, which is exactly the opposite of our localisation agenda.

Caroline Spelman: My hon. Friend makes a very good point indeed. He was a Member of Parliament when the Conservatives were in government, so he will remember that in marked contrast, there was a public consultation involving every household, which has not happened under the Government's proposals.
	The Secretary of State proposes to restructure local councils, and where that has taken place, I see very few attempts at genuine consultation. Should the Secretary of State not hold referendums? Is that not the most effective way of gauging public opinion, as was demonstrated by the referendums held in Shropshire? May I ask her whether she is confident of the legality of abolishing those councils? If the restructuring is found to be legal, which is a big "if", given the pending legal challenge in Shropshire, has she given any thought to the cost implications for council tax payers? Based on research by leading academics, the additional cost of restructuring could be as much as £345 per council tax-paying household.

Peter Soulsby: The hon. Lady is making a case against the restructuring of local government. If it is indeed as mistaken as she suggests, will she explain why almost half the councils seeking restructuring are Conservative-controlled?

Caroline Spelman: The hon. Gentleman ignores the point that three years after beginning a review of local government finance, the reviewer concluded that restructuring was an impractical way of dealing with the challenges faced by local government. I suggest that the hon. Gentleman wait for the Secretary of State to respond on the question of why she is at odds with the view of Sir Michael Lyons in his review of the future of local government finance.

Philip Dunne: My hon. Friend kindly referred to Shropshire and our pioneering efforts to resist the imposition of a unitary authority on an unwilling people who voted against it.

Phil Woolas: It is Conservative councils that are making the proposals.

Philip Dunne: The Minister may argue that the measure was taken at the request of Conservative councils, but he fails to point out that if those councils do not comply with Government proposals, they have been threatened that they will have to find savings, which will be imposed on them by the Government. Does my hon. Friend agree that Government Ministers will not have any power to single out individual councils to make the cuts that they have identified in that process?

Caroline Spelman: My hon. Friend is owed an answer by the Government. On previous occasions we have had no answer to the question of where in legislation there is the power to enable the Government to force the recovery of costs on councils that refuse to comply with the Government's model of restructuring.
	Even more astonishing to all of us watching the way in which the Government have imposed their will on local authorities is the fact that in Shropshire, of all places, the referendum produced a quantifiable result showing that there was no broad measure of support for restructuring, yet flying in the face of that opposition to restructuring, the Government allowed the unitary bid to proceed. That is difficult for us to understand and accept.
	People are being asked to pay more in taxation for less representation, without being properly consulted in the first place. Making that sound appealing must be the ultimate in political alchemy. How on earth does that square with localism? If we are serious about getting decision making closer to the people, surely we should be strengthening local councils, rather than abolishing them. Restructuring is about taking decision-making further away from local communities, just like that other great folly in local government, regionalism.
	Is the Secretary of State content with her Department's legacy being one of forcing unwanted and unelected regional government on people against their will, abolishing people's local council against their will, and then charging them a 92 per cent. premium on their council tax bill for the pleasure?
	Labour has played fast and loose with local government. The Deputy Prime Minister sold it down the river for the sake of his unelected regional empire, the Environment Secretary spent his time entreating chief executives to join him in abolishing one another's councils, and the Chancellor has spent a decade reducing councils to mere tax collection agencies, rather like a latter-day sheriff of Nottingham. I do not want our country to be governed like that.

Anne Milton: Does my hon. Friend accept that in my constituency, Guildford, the thing that makes people most angry is not only the exorbitant council taxes that they are now paying, but the feeling that they have no impact on what happens in local communities, that decision making is being taken further and further away, and that the Government are dictating to local councils and neatly hiding behind local decision-making when they choose to?

Caroline Spelman: My hon. Friend is right to highlight the fact that the Government have made the council tax the ultimate stealth tax and they are reaping the result of that decision. Shortly, at the local elections, we shall see the very strong public response to that.

Nicholas Winterton: I am in an odd seat tonight, but none the less I am on the Conservative Benches, and I hope that after my intervention my hon. Friend will still think I am a Conservative. Will she indicate whether our party will be prepared to return to individual local authorities the total income from the business rate? Local authorities have a huge responsibility to respond to the needs of local commerce and industry. At present the distribution of the business rate is anything but transparent, and Sir Michael Lyons believes it should be more transparent.

Caroline Spelman: My hon. Friend has a longer political history than I do, so he will well remember the original reasons why the Conservative Government took the business rate to the centre. Businesses were exposed to increases in rates which made it virtually impossible for them to carry on their businesses. The relationship of trust was damaged by profligate, often Labour, councils. For that reason, a decision was taken to introduce a uniform business rate. The relationship of trust between local government, central Government and the business community still needs to be rebuilt.
	That subject was addressed in the Lyons review, but the Government have already made it clear that at present they have no intention of repatriating the business rate to local government. That was their response to their own review. Rebuilding that relationship of trust between local government and business is of the utmost importance, because the business community is one group in our society that faces the dilemma of having taxation levied at the centre without one-for-one representation.

John Redwood: I am grateful to my hon. Friend, who is making a powerful case against the waste and unnecessary spending forced on local government by central Government. Will she confirm that there is over £1 billion a year of unnecessary expenditure on conforming with the performance targets and monitoring requirements of central Government, which shows how little they trust their own councils, let alone good Conservative ones? Would not one way of restoring trust be to strip that away so that the money can be returned to taxpayers or put into services? If people have a badly performing Liberal or Labour council, they can get rid of it on 3 May.

Caroline Spelman: I thank my right hon. Friend for his intervention. He points out clearly that a whole industry of inspection that did not exist before 1997 has been imposed on local government from the centre and has cost council tax payers £1 billion in hard- earned money. That money would be much better spent, as I suggested earlier when the question of social care came up, by being returned to the front line, where it is much needed. For the avoidance of doubt, we have said on many occasions, and I will repeat it again, that we would scrap the comprehensive performance assessment and best value, because we believe that that money could be better used elsewhere.
	I want local government to be the real engine room of local decision making, not a mere agent of Whitehall. I want town halls to have freedom and discretion to spend taxpayers' money in a way that reflects the needs of local communities. That is why we have proposed the Sustainable Communities Bill, a Bill which the Government rather complacently see as unnecessary. Giving local communities the right to decide the spending priorities for their area is necessary. It is also necessary to give planning decisions back to town halls, rather than regional quangos and Whitehall Departments. Crucially, it is necessary to get council tax back down to sustainable levels. When it was first introduced, people were not protesting on the streets and pensioners were not going to prison.
	Through their abuse, the Government have made the council tax a stealth tax that is extremely unpopular. It is not an unreasonable aspiration to return the council tax to sustainable levels, and there are significant savings in wasteful bureaucracy that could be directed to the front line. What we need is a change in the culture of government, from one that sees local government as an obstacle to one that sees local government as a solution.

Richard Younger-Ross: Will the hon. Lady give way?

Caroline Spelman: I fear we may have an intervention from a party that does not understand how local government, rather than regional government, is a solution offering the localism that is much needed in this country.

Richard Younger-Ross: I know all about local government. My Teignbridge district council, led by the Liberal Democrats, has managed only a 2 per cent. council tax rise during the past four years compared with the Tory's 32 per cent. over the previous years. The hon. Lady has just said that she wants to see the council tax cut to a reasonable level. We would all agree with that. Where will the money come from?

Caroline Spelman: The hon. Gentleman clearly has not been listening to the debate because I have explained that on at least three occasions, and most explicitly I quantified the savings that would accrue from scrapping the comprehensive performance assessment and best value. That currently costs taxpayers £1 billion a year—£1 billion that could be used much more effectively and is urgently needed in areas such as adult social care.
	It is clear to me that after 10 years of the Government eroding local decision making and fleecing council tax payers, the only way of creating that change in local government is through a change in national Government. That is why I invite voters to use 3 May to send precisely that signal.

Ruth Kelly: I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:
	"notes the transformation in local government since 1997 and the dramatic improvements in performance across a wide range of front-line services; recognises the achievements of local authorities and their staff with a record number of authorities awarded three or four stars for their performance by the Audit Commission in 2006; contrasts this with the under-investment and poor morale that the Government inherited in 1997; applauds the Government's radical and devolutionary local government White Paper as the next stage in the reform of local public services, strengthening local leadership and partnership working and empowering local communities; believes that the measures set out in the Local Government and Public Involvement in Health Bill will strongly promote sustainable communities, improving local environmental quality and the quality of life of local residents; congratulates the Government on the way in which it is providing stable funding for local government, increasing overall grants to councils by 39 per cent. in real terms since 1997 with the average council tax increase in England at 4.2 per cent. for 2007-08; and therefore supports the Government in implementing the White Paper and the Bill."
	Life in communities across England has improved enormously over the last 10 years. There are more jobs, our streets are cleaner and greener, and vital public services have improved. Those are real achievements, and the Government are proud of them. Local government should be proud of the role that it has played, too, leading the way in many areas. So I welcome today's debate on the future of local government.

Stewart Jackson: Will the Secretary of State give way?

Ruth Kelly: In a moment.
	But I am surprised that the Tories have launched this debate with so little to say. I had hoped that the hon. Member for Meriden (Mrs. Spelman) would take this opportunity to enlighten the House on the Conservative vision for the future of local government. Sadly, we are none the wiser on several key issues. I should like to ask three simple yet vital questions.
	First, what exactly is the Opposition's policy on council tax? Keep it? Scrap it? Reform it? We are none the wiser. Secondly, the Opposition claim to be in favour of devolution. So why did the hon. Lady, her colleagues and the Front-Bench team direct all Conservative councillors to oppose any restructuring, no matter what the council tax benefits to people who live in those areas? Should not those decisions be left to local councillors themselves?

Stewart Jackson: Will the Secretary of State give way?

Ruth Kelly: In one moment.
	Thirdly, the hon. Lady's party claims to want to give people more control over what happens in their local areas, so why does it not support the Government's devolutionary local government Bill? The hon. Lady seems to suggest that the answer to local government finance lies in scrapping regional assemblies, which have an administration cost of £21 million a year, and scrapping the comprehensive performance assessment, which is being replaced in the local government Bill. I am afraid that without the answers to the questions that I have set, the Opposition simply do not have a clear vision for the future, and in the absence of that, we should judge them on their past and present record, which I shall come to in a moment.

Chris Mole: Will my right hon. Friend ask the hon. Member for Meriden (Mrs. Spelman) a fourth question, which is: in a debate where we should be celebrating local democracy and local decision making, did she really just say that the public should vote in a national referendum on the performance of the Government in local elections? That is what I heard her say, and that to me is a complete contradiction of the whole essence of local democracy and its purpose.

Ruth Kelly: My hon. Friend, who has a strong track record in these areas, makes an absolutely vital point. The Opposition need to decide whether or not they trust local councils.
	But we should look for a moment at what the Opposition did to local government when they were in power. Perhaps Conservative Members would like to intervene on that point.

Philip Dunne: I should like to intervene on the question of trusting the people and believing that individuals have a right to say how they want their local government to be run. Where they take a ballot, the Government completely ignore it. Does the Secretary of State believe in local democracy or not?

Ruth Kelly: I know that the hon. Gentleman is very concerned about the issues in Shropshire, but I remind him that it is the Tory-controlled council there that has proposed to Government that it should be able to run a unitary council. It is the Tory-controlled council in Shrewsbury that has decided that it will not go down that route. Perhaps it should pick up the phone and call Dave, rather than have these arguments in the House. Somewhere, someone needs to sort these things out.
	The Tories' record on local government when they were in power speaks for itself. Yesterday, the right hon. Member for Witney (Mr. Cameron) acknowledged that the 1980s had brought centralisation of power and control. But he did not take the opportunity to mention the under-investment, the neglect, or the sheer arrogance that characterised the Tory years. He certainly did not mention the devastating impact on all our communities. The Opposition may not care to remember, but millions of people throughout the country do. They remember the years of diktat and demoralisation. They remember the funding cuts. Even in their last four years, the Tory Government slashed funding by 7 per cent. in real terms. Millions of people remember schools with leaking roofs and outside toilets. They remember the contempt for local democracy. They remember Nicholas Ridley's maxim on councils: "The more they squeal, the more I know I'm right." They remember Tory Ministers' disdain for the local government work force. They remember the thousands of committed workers who had to fight for their pensions and holidays as a result of compulsory competitive tendering. We all remember the low point of the poll tax, with councils and Government locked in bitter opposition and people rioting on the streets. That is the history. Those are the facts of what the Conservative party did to local government when it was in power.

James Gray: The Secretary of State makes a powerful point about how the people hate the Conservative party in local government. If that is the case, why is it that the Conservatives now control twice as many councils as all the other parties put together and have twice as many councillors?

Ruth Kelly: I remind the hon. Gentleman that according to the figures of the hon. Member for Meriden, the Conservative party now controls 167 councils out of a total of more than 450. I suggest that local people sometimes have some common sense.

David Curry: If it is true that the general public believe that the Conservative years were so catastrophic and the Labour years so uplifting, how many gains does the right hon. Lady expect to make for Labour councils in 10 days' time?

Ruth Kelly: May I just remind the right hon. Gentleman, whom I hold in great admiration, that in areas such as Manchester and Sheffield there is still not one single Conservative council, for the very good reason that Labour has revitalised the towns and cities in the north in a way that has never been managed before.
	The right hon. Member for Witney tries to convince us that things have changed. But we need only look down the river to Hammersmith and Fulham to see the Thatcherite flame still burning bright today. The local Conservatives are proud of their first budget; proud of cutting essential services to support a tax cut; proud of making meals on wheels £200 a year more expensive for some of society's poorest and most vulnerable people; proud of making it harder for the elderly and sick to get home help.

Eric Pickles: rose—

Ruth Kelly: Before I give way to the hon. Gentleman I just want to ask the hon. Member for Meriden whether she supports what the local Tories are doing in Hammersmith and Fulham. I give way to the hon. Gentleman after a resounding silence from the hon. Lady.

Eric Pickles: I actually went to that council meeting and I have to tell the right hon. Lady that the Labour group did not vote against that budget cut. I also have to tell the right hon. Lady that I heard the Labour leader of Hammersmith and Fulham say that they would have produced a lower council tax and they would have cut deeper.

Ruth Kelly: If the hon. Gentleman is right, why is it that the Labour party in Hammersmith and Fulham is reporting the Tory-controlled council to the Audit Commission for the changes that it is making? I take it from the hon. Gentleman's response and from the resounding silence from the hon. Lady that this is the Tory future vision for local government—charges and cuts.

Andrew Slaughter: rose—

Ruth Kelly: I give way to my hon. Friend, who has some real experience of life in Hammersmith and Fulham.
	Hon. Members: Tory gain!

Andrew Slaughter: One of the reasons why it was a Tory gain might be that in their manifesto last year the Conservatives said that a Conservative council would not reintroduce home care charging, yet last week they proposed an £11 a week charge for the most vulnerable people who need home help. In other words: "Say something when you want to be elected, and when you get elected do exactly the opposite." Perhaps that is what we can expect on 3 May.

Ruth Kelly: I thank my hon. Friend— [ Interruption . ]

Mr. Deputy Speaker: Order. I want Opposition Front Bench interventions only if they are proper in nature, not sedentary.

Ruth Kelly: Thank you, Mr. Deputy Speaker. I must make some progress with my speech.
	It is clear that the Opposition do not like to talk about their record in power or when they were last in government. I can tell the House that we are proud of our record. In 10 years, Labour has transformed local government. We inherited services that were run-down, demoralised and starved of cash. Since 1997, we have increased funding to local councils by 39 per cent. in real terms. Our massive investment, together with the commitment of local government workers, has turned things around. Today, local government is not just up to the job: in many areas, it is leading public service reform. It is delivering results on the issues that really matter. Rates of recycling have more than tripled in the past eight years, antisocial behaviour is falling, 3,500 neighbourhood wardens are helping to cut crime on our estates, and the streets are getting cleaner. The Audit Commission shows councils improving year in, year out.

Ian Austin: I remind my right hon. Friend of the appalling failure of the hon. Member for Meriden (Mrs. Spelman) to condemn the activities of Dudley council, which, despite having received an above-average settlement this year, is increasing council tax by 5 per cent., cutting services for the elderly and special needs children, and even closing swimming baths. Will my right hon. Friend, on behalf of the House, condemn what Dudley's Conservative-controlled council is doing? Will she look at her diary to try to find an urgent opportunity to come to Dudley and see for herself the reality of Conservatives in power in Britain today?

Ruth Kelly: I condemn what the Conservatives are doing in Dudley and think that it is a disgrace that the hon. Member for Meriden has not condemned them. I will certainly look for an early opportunity to visit my hon. Friend's constituency.

Phyllis Starkey: In relation to my right hon. Friend's remarks about recycling, can she try to explain how the Conservatives square the circle whereby they wish to be environmentally friendly in encouraging recycling, yet, in their motion, cite weekly rubbish collections as a bad thing although that can be the most sensible way of encouraging people to recycle more and to have lower amounts of residual waste?

Ruth Kelly: My hon. Friend makes an excellent point. I do not think that the hon. Member for Meriden can square the circle. On the one hand she talks about devolving real power to local councils and local people; on the other, she still seems to believe in central diktat from Whitehall. She cannot have it both ways.

Stewart Jackson: Will the Secretary of State give way?

Ruth Kelly: I will make some progress.
	Under this Government, we have had 10 years of local government going from strength to strength. That has paved the way for devolution to the town hall and from the town hall. Those are the principles behind the ambitious reforms set out in the White Paper that I published last year and in the Bill that is currently before the House. Our proposals are the culmination of many months' work and extensive consultation.
	Now that local government has raised its game, the next stage is to give it greater freedom, greater discretion about how it meets its goals, and the opportunity to build places that people are proud to call their home. It is time for local government to empower its citizens and to give them a greater say over the services they want and how they are delivered. This is what our proposals achieve. That is why they have cross-party support in the Tory-led Local Government Association.
	Let me remind the House of some of the measures that we are introducing. We are introducing the community call for action. Where people have concerns about a local issue, the call for action will help them to get a response from their council. It could be graffiti; it could be youth facilities: whatever the issue, local people will have a new way of getting things done. We are freeing local government to get on with the job by slashing red tape. We are strengthening local area agreements, which set out what councils and key partners will deliver for local people, and how. I believe that in the future they will be one of the great success stories of local government. We are trusting councils to understand the needs of local people, and giving them greater freedom to meet them.

Stewart Jackson: rose—

Mark Francois: Will the Secretary of State give way?

Ruth Kelly: Not at the moment.
	Indeed, last week the hon. Member for Brentwood and Ongar (Mr. Pickles) described local area agreements as "the future". I welcome his support. Does the hon. Member for Meriden agree with her hon. Friend, or does she still believe in the central diktat of the olden days?
	The proposals in the White Paper and the Bill will make a real difference. They will help local government to take on the challenges of the 21st century. If the Conservatives support localism, as they say, why have they consistently opposed our Bill? Is it because they prefer rhetoric and photo shoots to the tough policy decisions that government is all about?

Stewart Jackson: rose—

Ruth Kelly: I give way to the hon. Gentleman.

Hon. Members: Hooray!

Stewart Jackson: I thank the right hon. Lady for her generosity. I am a patient man.
	The hon. Member for Ipswich (Chris Mole) made the sensible point that local elections are about local people making a local choice. If everything is so wonderful in the land of milk and honey under this Labour Government, why is the Labour party failing to contest 40 per cent. of all the council seats at the elections on 3 May? Is it because it has not got a record worth defending in those seats?

Ruth Kelly: I do not recognise that figure, but I would ask the hon. Gentleman why the Conservatives have made no inroads whatsoever into any of the cities in the north.
	I saw that the right hon. Member for Witney was in Dartford last week gathering rubbish; I read the report of his performance in  The Times. The council leader explained how that event was set up:
	"I can tell you 100 per cent. that the rubbish was on that site and was not brought in. In fact, we left it there a day longer than it should have been because we knew Cameron was coming."
	That sums up the right hon. Gentleman's contribution to local services.

Barbara Keeley: Does my right hon. Friend agree that part of the difficulty that the Conservatives have in getting people elected in the north, particularly in cities such as Manchester, might be the example of Tory-led Trafford council? Perhaps it is time to condemn that council, which is not prudent. It has not only increased its council tax by the largest amount in Greater Manchester—4.9 per cent.—but is making its citizens pay the council tax every month on days earlier than they are used to paying it, and has wasted money on the new council logo and £400,000 on consultants at the same time as closing two day care centres and an elderly people's home.

Ruth Kelly: I certainly condemn the Tory councillors on Trafford council. It is worth reminding the House that those in Labour-controlled councils are seeing their council tax go up by much less than those in Tory-controlled councils throughout the country.
	I must turn to the interest that the hon. Member for Meriden expressed in our council tax policy, as she made so much of the Lyons report in her speech. That gives me a chance to set the record straight. We have no plans to revalue properties in this Parliament. We have no plans to introduce new higher and lower council tax bands in this Parliament. We have no plans to replace bands altogether with a system based on the individual value of each home. The Tory policy on council tax seems to consist of tabling endless parliamentary questions about patios and bathrooms while dreaming up stories to scare people about spies in the sky and inspectors who are going to kick the door down. If one were to believe them, one would think that every home has a helicopter hovering above it taking pictures of patios and every bed has a home inspector lurking beneath it. One of my favourite parliamentary questions is the one tabled by the hon. Member for Meriden that asks what is the Valuation Office Agency's definition of a bathroom and whether a room with a shower but not a bath is classified as a bathroom.
	People could be forgiven for having expected the hon. Member for Meriden to set out the Conservatives' policy on council tax today: would they keep it, would they scrap it, or would they reform it?

John Redwood: The Secretary of State is struggling, so I shall help her. Does she agree that any council candidate who supports a local income tax and implies that it will be cheaper is guilty of two sins of deception? The first is that council elections do not settle the introduction of a local income tax. The second is that it will not be cheaper.

Ruth Kelly: On that point, we can agree.

Caroline Spelman: rose—

Ruth Kelly: I shall give way to the hon. Lady, who is obviously keen to set the record straight on bathrooms.

Caroline Spelman: On a point of order, Madam Deputy Speaker. Is it in order for the Secretary of State to mock the device of the parliamentary question that is open to hon. Members to elicit factual information from the Government— [Interruption.]

Madam Deputy Speaker: Order. I cannot hear the hon. Member's point of order.

Caroline Spelman: Is it in order for the Secretary of State to mock the legitimate use of the parliamentary question as a method of enticing from the Government vital information about their tax plans, perhaps not in this Parliament, but immediately after a general election?

Madam Deputy Speaker: Having heard the hon. Lady's comments, I have to tell her that that is not a point of order for the Chair.

Ruth Kelly: I would not have drawn the House's attention to the hundreds of parliamentary questions that the hon. Lady tables if she had anything else to say about the council tax, but I am afraid that she has not. I waited for tonight's debate with great anticipation, but yet again I am none the wiser.

Martin Horwood: Since the Secretary of State is pressing the other council tax party for answers on council tax revaluation among other things, will she say whether she agrees with Sir Michael Lyons that
	"an out-of-date tax base will mean that the credibility of council tax as a property tax will gradually be eroded"?
	He says that he understands the Government's reasons for delaying the decision until after the general election. What are they?

Ruth Kelly: The hon. Gentleman could not have expected me to be any clearer than I have been. We have no plans for revaluation in this Parliament. Michael Lyons is welcome to his view—after all, he prepared an independent report for the Government—but we will not revalue in this Parliament.
	Local government plays a vital role in our communities. The Labour party has a clear, ambitious and workable vision for councils to thrive in future and a strong record on which to build. Political parties will ultimately be judged on results, not rhetoric, and on policies, not posturing. The warm words of Conservative Members count for nothing with those who remember the cold comfort that a Tory Government brought to councils.
	Perhaps that is why the Conservative party is so poorly represented not only in major cities such as Liverpool, Manchester and Newcastle but in Scotland and much of Wales. If the Conservative party is serious about localism, it needs to match its words with action. If it is serious about making local services more responsive, Conservative councillors need to show it. If Conservative Members want to make a genuine difference, surely it is time they stopped scaremongering and supported the Local Government and Public Involvement in Health Bill. I invite them to do that now. There is no response.

Caroline Spelman: The Secretary of State has ignored a major issue in the Bill about which we have had no comfort from the Government. She is willing to grant herself the power to direct councils to restructure. That is a draconian power, to which we strongly object. She knows that that forms the basis of strong opposition to the measure.

Ruth Kelly: The hon. Lady considers that to be an incredibly important issue—so important that she did not raise it in her speech. She did not note the fact that the Tory-controlled Local Government Association understands the reason for the power, which is temporary, so that if local councils make unitary proposals, we can ensure that they are workable and coherent across the piece. If the inclusion of the power was the reason for her lack of support for the Bill, perhaps she will change her mind. I made a commitment at the time to table an amendment to restrict the power of restructuring and, together with the Local Government Association, we have now made clear our intention.
	Soon, many people throughout the country will have a clear choice. For those who believe in investment over cuts, a clear vision for Britain's communities and a party that puts its money where its mouth is, there is only one choice—Labour on 3 May.

Andrew Stunell: Liberal Democrats greatly welcome the time that has been set aside for the subject of the debate. If we want a healthy democracy and a responsive and participative society, with effective and efficient services, we must have strong democratic institutions at every level, especially in local government. There could hardly be a better time to debate the future of local democracy and local government than 10 days before the biggest round of local government elections in England for four years, and on the eve of some historic local government elections in Scotland, for which a proportional voting system will be used for the first time.
	This evening we have a chance to examine the competing plans of the political parties for strengthening and enhancing democracy and for better participation in our society. It is an opportunity to consider parties' plans for delivering effective local services and improving the well-being of our local communities.
	It was therefore a genuine disappointment to be presented with the Conservative motion. The shadow Minister, the hon. Member for Meriden (Mrs. Spelman), did her best, but even her best could not disguise the fact that the motion contains only half an analysis of the problem, no diagnosis and no effective remedies. For long sections of her speech I thought that she was reading a succession of Conservative election leaflets. She paid little attention to the severe and serious problems that we should be addressing when we discuss the future of local government.
	The Conservatives' first motion today took up only 18 lines on the Order Paper, and their second only nine lines. It is a pity that they did not find another few lines to add to their second motion to give us a clue, a faint hint or even the ghost of an inkling of what they believe should be done to ensure a secure future for local government.

Paul Farrelly: It is interesting that Liberal Democrat Front Benchers oppose the Conservatives. In my constituency, the Liberal Democrats are in power on the council for the second time. The first time, they went into coalition with us when we temporarily lost control in 2002. Now, strangely enough, they are in coalition with the Conservatives after we temporarily lost power last year. Where do the Liberal Democrats stand?

Andrew Stunell: The Liberal Democrats stand on our policies of fair local government services properly provided and service to the community. I am proud to say that we implement them in every part of local government where we have the power and opportunity to do that.
	The hon. Member for Meriden, despite her best efforts, could not say what the Conservatives intended to do and we are therefore left with having to examine the Conservative party's record. That raises an important question. How on earth have the Conservatives got the cheek to table a motion on the future of local government given the huge part that they played in bringing it to its current plight? The hon. Lady is right that local government is over-centralised and prescriptive. In many ways, local government services and local democracy are diminished compared with 10 years ago, and especially 20 years ago. What exactly does she plan to do about that? What does she believe is wrong now?
	We heard some of the things that the hon. Lady believes are wrong. Some were amusing. Apparently, revaluation is wrong. Let us consider what will happen in this place after the next general election. We believe that we know what the Labour party will do—it will revalue and change the council tax; we know what the Liberal Democrats will do—introduce a local income tax; but we have not the slightest idea what the Conservatives will introduce. They are against revaluation and rolling revaluation; they are against changing the bands; they want council tax to be cut; they want local government and local democracy to walk on water. The hon. Lady has evidently forgotten that the Conservatives were responsible for the Act of Parliament that introduced council tax, after they had abolished—after introducing—the failed poll tax. That very Act includes the provision for revaluation that she seems to be so against.

Geoffrey Clifton-Brown: rose—

Philip Dunne: rose—

Andrew Stunell: I am a bit surprised that the hon. Lady did not make the entirely different point that she rather doubted whether the Government could find enough inspectors to carry out all these revaluations of which she speaks. I have observed that a number of Conservative Members want to intervene. Who shall we take? I will take the hon. Gentleman at the back of the Chamber.

Geoffrey Clifton-Brown: The hon. Gentleman has made it quite clear that it is his party's policy to have a local income tax. The flaw with it, apart from the cost, is that it needs a redistributive mechanism, because the tax base is not conveniently where one wants the funds to be distributed. What discussion has he had with the Inland Revenue and what does he believe the compliance cost of a local income tax would be? What confidence does he have in the Inland Revenue in respect of the redistributive element in the light of the mess that it made of the working families tax credit?

Andrew Stunell: I am not sure whether the hon. Gentleman got right the way down the Conservative briefing on that point, but he certainly asked a number of interesting questions— [Interruption.] Let us be absolutely clear. The nature of the questions strongly suggests to me that he has not taken the opportunity of reading what Sir Michael Lyons said about local income tax: it is a thoroughly practical tax with many advantages, but will take some time to introduce. It is rather like the reform of the council tax that the Labour Government are talking about and very different from the fossilised, "stay as you are" solution that the hon. Gentleman's party is currently recommending.
	Let us deal with the issues that the hon. Member for Meriden said were at the heart of the problems facing local government. Unitary authorities seem to be the problem. Well, the Conservatives thought of unitaries first. They introduced them in Wales and Scotland and they have introduced them in Avon and Berkshire. Indeed, four Conservative county councils are currently bidding for unitary status. Unitaries have their place, especially where there is clear local support and validation. I fully understand that— [Interruption.] I am expecting an intervention any second from the hon. Member for Ludlow (Mr. Dunne) to the effect that what I am saying does not apply in Shropshire. Let people sort out their grief locally, as those matters should be decided at local level.

Paul Farrelly: rose—

Philip Dunne: rose—

Andrew Stunell: I shall take the intervention of the hon. Member for Newcastle-under-Lyme (Paul Farrelly) first.

Paul Farrelly: The hon. Gentleman seems about to move on to forms of local government, but I have not quite finished with council tax. I am not sure what gimmick the Liberal Democrats will propose from year to year. They have a policy one year, and if it does not work they change it. I remember that one year in Newcastle-under-Lyme the Liberal Democrats promised everyone £100 back from their council tax bills. The cheque was inconveniently dated 1 April. How can anyone believe what the Liberal Democrats say from one election to another when they flip-flop as it suits them between Tory and Labour?

Andrew Stunell: That has obviously come from the Labour party briefing and is, of course, completely mistaken. We have supported local income tax to my certain knowledge for 22 years and the policy may go back even further than that. What we definitely need for our local democratic institutions to function properly is a secure source of locally determined income. The flaw in the existing council tax and, to an even greater extent, in the fossilisation of it proposed by the Conservatives is that such a secure source would be restricted. Indeed, they would mean a cutting back of the opportunities for local democracy to flourish. I believe that I promised the hon. Member for Ludlow that I would give way to him.

Philip Dunne: The hon. Gentleman seeks to characterise the past 10 years of Conservative action over council tax, so I draw to his attention the fact that residents in South Shropshire, which has been Liberal Democrat-administered for the past four years and partially so for the whole of that period, have had to suffer the second largest increase in council tax in the country—beaten only, I believe, by Kingston upon Thames, which is another Liberal Democrat-controlled council. The reason why the hon. Gentleman wishes to deflect attention from council tax to local income tax is that Liberal Democrats cannot manage council tax efficiently for their residents.

Andrew Stunell: If the hon. Gentleman looked at the record of Liverpool city council or, indeed, that of my colleagues in Islington in north London, he would see a very different picture. He should take a look at the percentage increases as compared with cash increases. I would not mind betting that the council tax in South Shropshire is currently lower than it is in some of the flagship authorities that the hon. Gentleman is so proud of.

Caroline Spelman: The original legislation that brought in the council tax made provision for revaluations, but under certain circumstances where there was a disparity between regional house prices and the ratios prescribed between the different regions of the country. The fact remains that the ratio between the regions is the same today as it was when council tax was introduced, so there is no need at present for a revaluation.

Andrew Stunell: I find the hon. Lady's argument rather tenuous. If that is the case and it is the core of what she is arguing, it is surprising that she did not make the point in her speech. If she is arguing that we need some sort of regional variation to council tax plans based on property prices, she could well have said it in her speech and perhaps we could have examined the proposition.

Martin Horwood: Does my hon. Friend agree that the Conservatives are demonstrating that they have not really read the Lyons report at all, which is quite clear that revaluation should have taken place? Sir Michael Lyons also clearly said:
	"I am satisfied that a local income tax could be feasible in England and could viably replace all or part of council tax"
	and that it would be more progressive and more popular.

Andrew Stunell: I certainly agree with Sir Michael on that, if not on every other proposition that he has put forward, and I am very grateful to my hon. Friend for drawing that to the House's attention.
	A number of other factors handicap local democracy and local councils and it is interesting to reflect on things that the hon. Member for Meriden did not mention. She did not mention capping. Of course, the Conservatives thought of it first. She did not mention the arbitrary abolition of local authorities, because the Conservatives did that as well. She did not mention explicitly charges for council services, though she did mention rubbish collections. What she did mention was the pressure on social care for local authorities. Of course, she is right about that, but what she did not say was that it was her Government who introduced charging for social care at local level in the first place. That charging is creating some of the difficulties that have already been illustrated in the debate. I make the point in passing that if we had the same policy for free nursing care south of the border as they do north of the border there would be a very different set of pressures on people.
	The hon. Lady is right that there has been excessive centralisation, but it was certainly triggered and, in some ways, masterminded by the Government whom she supported. I remember as a member of a county council 20 years ago how responsibility for the police, magistrates and probation were taken away and how the district council had buses confiscated. That was centralisation of a different order indeed.
	I see the hon. Member for Mole Valley (Sir Paul Beresford) in his place. He has probably forgotten—indeed, he probably never registered the fact in the first place—that he and I were in the same room together in the dim and distant past, sitting on the so-called Consultative Council for Local Government Finance. It was not very consultative. The hon. Gentleman was one of the Ministers sitting on one side of the room; I was one of the local government representatives sitting on the other. I had been on a deputation to see the hon. Gentleman to discuss council funding and to seek help from the then Department of the Environment. Going as a representative of a local authority to ask for better treatment from a Government Department certainly gives one a worm's eye view of how democracy works in this country. That was not a devolutionary experience.
	The hon. Member for Meriden is asking us to believe that something has happened, that the hon. Member for Mole Valley has had an event on the way to Damascus, and that St. Paul is now going to be lowered in a basket from the Marsham street towers to get away from all those centralists.

Geoffrey Clifton-Brown: The hon. Gentleman seems to be railing against centralisation rather than local decision making. Will he explain his party's policy towards regional government? If he does not like regional government, does he acknowledge that it is being used as an excuse to rescue the Liberal Democrats from badly run Liberal councils?

Andrew Stunell: What I like about the hon. Gentleman is his capacity to read his Tory brief. What I do not like is his incapacity to understand Liberal Democrat policy, which is to take powers from central Government Departments and bring them back to the regions and local authorities, where they can better be exercised. I am astonished that he has not grasped that. Given that he has not grasped it, I wonder how he can support those on his Front Bench who say that they want more devolution. He does not seem to understand what devolution is or how it works.

Mark Francois: rose—

Paul Farrelly: rose—

Andrew Stunell: Let me take these interventions from alternate sides. I give way to the hon. Member for Newcastle-under-Lyme (Paul Farrelly).

Paul Farrelly: I can assure the hon. Gentleman that this is all my own work, because the one omission from my brief is that there is no mention of the Liberal Democrats. I hope that the Secretary of State will look into that for next time. I am still grappling with all that I have heard about the proposed local income tax. The hon. Gentleman and I come from the west midlands, which is a region. Will he please tell me what the upper percentage limit for local income tax would be in that region? If he cannot give an answer, presumably it is because the Liberal Democrats have not worked it out yet, or because there will be no upper limit.

Andrew Stunell: We supplied figures to Sir Michael Lyons. Assuming that the income tax rate includes the upper income tax band, it would be 4.5 per cent. I hope that that satisfies the hon. Gentleman. A great deal of practical detail and information is available on that subject.

Mark Francois: Will the hon. Gentleman give way?

Andrew Stunell: It is probably time for me to make some progress, if I may. [Hon. Members: "Give way!"] Well, okay, let us take another one.

Mark Francois: I am grateful to the hon. Gentleman for his courtesy. He will know that the Secretary of State's policy is to impose large numbers of houses on local authorities through national and regional housing targets, irrespective of whether they have sufficient infrastructure to accommodate them. She is doing that even though she frequently objects to planning applications in her own constituency. What is the Liberal Democrats' policy on regional housing targets? Are they in favour of them, even when local authorities resist?

Andrew Stunell: We clearly need more homes, and there needs to be a way of allocating them. We have said clearly that there needs to be a partnership in that decision-making process. It is just as absurd to have regions attempting to impose more houses on their local authorities as it is to have regions restricting local authorities that want to see growth, yet both of those situations exist—

Mark Francois: So is that a yes or a no?

Stephen Pound: It is building on the fence.

Madam Deputy Speaker: Order. May we please follow the rules of parliamentary debate? We are getting far too many comments from a sedentary position.

Andrew Stunell: Thank you, Madam Deputy Speaker. I am more than happy to explore the intricacies of housing policy and national allocations, but I suspect that we are probably straying from the broad themes of the debate. It is certainly the Liberal Democrat view that decisions should be taken at the lowest practical level, and that relates to planning decisions just as much as to financial and service decisions on health care, highways and public transport. Any diligent listener to our debates in this place should be well aware of that.
	It is disappointing that, when the official Opposition create an opportunity to talk about the future of local government, they fail to take it. The motion has offered us nine lines of nothing to debate, and it is hard to believe that their conversion, as announced from their Front Bench, is genuine. I looked for a local government policy in the Conservative party's previous manifesto, which I understand was drawn up under the supervision of their current leader, the right hon. Member for Witney (Mr. Cameron). I found a policy with a hard figure on it: a £500 council tax rebate for pensioners over the age of 65. No doubt that seemed an attractive vote-winner somewhat analogous to the £100 that has been mentioned. What it is, however, is another step in centralising local government finance and reducing the independence of local government, which is exactly the opposite direction to that mentioned by the hon. Member for Meriden. Perhaps that is a good reason for not mentioning any policies whatever: the only one that seems to be extant goes in the opposite direction to the philosophy outlined.
	In the years since the Conservatives left power, the Government have taken many steps in the wrong direction. During the passage of the Local Government and Public Involvement in Health Bill and at other times, my party has spelled out its concerns. As a Liberal Democrat, I am proud that we could table an amendment that set out clearly our prescription for the difficulties faced by local government. First, we need a proper proportional voting system for the election of local councillors, which will ensure much more representative and responsible local government. Secondly, we want a secure financial base for local government, which means returning the business rate to local control and introducing local income tax. Thirdly, we want a partnership of equals between local and national Government. I am only sorry that we will not have the opportunity to test those propositions in the Lobby tonight.
	Liberal Democrats in local government have a proud record of service to their local communities in every part of the country, from the deepest rural areas to suburban and inner-city areas. The people of our country are happy and ready to support Liberal Democrats in those situations, but until the House has the guts and determination to change the balance of power fundamentally between local and central Government, Whitehall and town hall, our country and our democracy will lose out.

Several hon. Members: rose —

Madam Deputy Speaker: Order. I remind right hon. and hon. Members that Mr. Speaker has placed a 10-minute limit on Back-Bench speeches. In view of the time and the number of Members hoping to catch my eye, however, Members might want to reduce their contributions voluntarily.

Michael Wills: Whenever the future of local government is debated, it inevitably becomes a discussion about the need for greater localism. Few Members would dispute that when localism means greater local management and devolving more power to front-line management, it is highly desirable. Local accountability and control, however, raise more difficult questions. I will discuss that in relation to my constituency in Swindon.
	Funding lies at the heart of accountability, and as long as national Government are responsible for allocating some proportion of local authority funding, local accountability and control will be limited. National Government remain accountable to national taxpayers for the money that they spend, and therefore need to retain some measure of control over how effectively it is spent. It is important that local authorities are not required to raise all the funds that they need locally, because the uneven distribution of resources across the country would inevitably result in an inequitable meeting of needs. Moreover, in my experience in Swindon, the Government's ring-fencing of funding to ensure that the greatest needs are met first, whatever the competence or bias of the local authority, has protected some of the most vulnerable people.
	In my constituency, the Conservative council has demonstrated repeatedly that the poorest and most vulnerable people in the borough are not among its priorities. Cuts made by the council have always tended to fall most heavily on the most vulnerable. For example, it has butchered the Parks advice service, which served the most disadvantaged people in Swindon. Its grandiose launch of a vision for Swindon in 2010 contained 50 promises, not one of which mentioned tackling poverty, deprivation or disadvantage. Despite the fact that Seven Fields primary school, in the most disadvantaged ward in my constituency, was falling down, it took months of public campaigning to persuade Swindon borough council—even after it had received unprecedented capital funding from the Government that would more than cover the cost—that it should allocate funding to rebuild it.
	What matters to the individuals who depend on public services is not an ideological fixation with localism, however it is defined, but the construction of the most appropriate partnership between local authorities and national Government to ensure that need is met equitably everywhere. Of course, such partnerships will vary according to the circumstances of each local authority, and earned autonomy has its place alongside direct intervention from the centre, but advocating pluralist partnership of this kind does not constitute an argument for the status quo.
	We have heard a few stray remarks from Members on both sides of the House about the importance of transparency in the relationship between local government and national Government, and I associate myself with those remarks. The current relationship needs to change. It is not that I think transferring power from one bunch of politicians to another bunch of politicians will necessarily improve the position. The key at all levels of power is accountability, and at both local and national level politicians clearly need to become more accountable. My primary concern is that the relationship is opaque and does not encourage leadership at local level. The experience of Swindon exemplifies that. A recognition of the role of partnership and of the part played by other partners is a crucial requirement for all leadership, but Swindon borough council is currently failing in that regard.
	Since it became a unitary authority in 1997, the council has struggled to deliver the services that Swindonians deserve. The problem is simply that it is too small to be a unitary authority and has struggled to find the capacity that would enable it to do all that it needs to do. That, coupled with a cynical division of resources by Wiltshire county council in 1997, left the Labour group, which ran the council until 2001, struggling. It failed to deliver what was necessary, as its members recognise.
	When the Conservatives took over in 2001, the electorate expected them to do better; but the electorate were disappointed because they were not able to do any better. Social services continued to receive zero stars and the local education authority remained in special measures. Today, however, Swindon borough council is improving. I pay tribute to the officers—now ably led by a new chief executive—for all the work that they have done, but the crucial turning point was intervention by the Government. The Department for Education and Skills drove through a new structure for education, and the Office of the Deputy Prime Minister, as it then was, worked tirelessly to teach Swindon borough council how to transform the delivery of services. Thousands of pounds were spent on teaching Conservative councillors how to do their jobs properly. Since 2001, funding from national Government has increased by well over 30 per cent., supplemented by one-off additional funding such as £1 million for building capacity. National Government have enabled the borough council to take part in a local area agreement that is innovative and will make a huge difference to the people whom I represent.
	Of course, councillors from all parties deserve credit for their willingness to embrace the agenda for change, and I pay tribute to the current Conservative leader for his determination to improve the town. The fact remains, however, that the improvements would not have been possible without all that funding and support from the Government, and—crucially—we have never heard a word of acknowledgement or thanks from any Conservative councillor. Reading Conservative councillors' election literature, one would think that they had personally raised the money to build all the new schools for which they are now claiming credit, not to mention the libraries and other community services on the basis of which they are trying to persuade people to vote for them. That is no way to provide decisive and visionary leadership. Any consistently visionary and successful local leadership must be based on coherent and consistent policy positions, which is not the case in Swindon.
	Swindon is a growth area, and it is expected that 35,000 new houses will be built there. Privately, Swindon borough council wants that to happen, subject to the provision of proper infrastructure; publicly, it says that it is a threat being imposed on them. To say one thing privately and another publicly—to say one thing in Swindon and a different thing in London—does not provide leadership for the people of Swindon; nor does it provide any basis for the relationship between all the strategic partners who need to work together to secure Swindon's future.
	All partnerships depend on trust. Trust and partnership cannot exist together when one partner persists in saying contradictory things to different audiences depending on a narrow and sectarian view of what they think will maximise their vote. We must have greater clarity about mutual responsibilities. If there is greater clarity about the relationship between local and central Government, that will stop this kind of dodging and diving and encourage local authorities to show more leadership.
	I shall now heed your strictures, Madam Deputy Speaker, by concluding. I hope that in his reply my hon. Friend the Minister will take note of the need to provide greater transparency, so that all the partners in delivering services to people who depend on them will acknowledge their role in a mutually supportive partnership.

Paul Beresford: I shall be succinct. I wish to make only two points, which I am delighted that the Minister is present to hear as they are aimed predominantly at him.
	First, I recommend that the Minister change the system of listening to local government following the distribution process. My right hon. Friend the Member for Skipton and Ripon (Mr. Curry) and I regularly did that, and the hon. Member for Hazel Grove (Andrew Stunell) mentioned it. Some councils have good causes and it is possible to change things to help them. In respect of others, revealing information can be discovered, especially if one does a bit of work beforehand. I found a few Labour councils to be difficult in terms of some of the positions that they took, and I found that some Liberal Democrats' positions were extraordinary.
	I cannot remember if it was the Liberal Democrat group that came with the Minister for Hazel Grove, or rather the hon. Member for Hazel Grove—that might have been a Freudian slip, although I hope that we never have a Minister from the Liberal party. The Liberal Democrat council members came after having worked all night—or so I was told—on a project, and they were determined to put their case, which they did. We listened carefully to them. Their case was demonstrated with graphs, until it was pointed out by me and one or two of the officials that if the axis of the graphs were changed slightly exactly the reverse argument to that they were making applied. That is an entertainment that I suggest the Minister tries. He will find that the position of the hon. Member for Hazel Grove is often pretty fraudulent.

Andrew Stunell: I am happy to report that that group was an all-party deputation from the authority.

Paul Beresford: What a shame—I could have gone on a little further, but I do not have the time.
	My second point is that the Secretary of State and Ministers have in the past gone on at some length about the fact that they were removing some of the ties and burdens on local government. That was a little fraudulent because the burdens referred to had been imposed on local government by this Government. It is a bit like someone having an arm handcuffed to a wall for a number of years and then the people responsible saying, "We are now going to release you," and then asking him whether he feels better—when at the same time another Department has nailed his other arm to the wall.
	Some of the effects can be followed. The best value system was introduced—that title is a misnomer if ever there was one—as was the comparative performance assessment, which brought with it myriads of targets and books of prescriptive guidance, and other Departments joined in. The best example I can give involves Mole Valley district council. It is a tiny council with a budget of £10 million. The last comparative performance assessment cost it £250,000, plus weeks of getting ready and dealings with auditors and so forth. The Audit Commission has been mentioned—I understand that it is five times greater than when we left power and Labour came to office—and it is merely hounding local government. When that £250,000 was geared—it is geared, as it moves on to council tax—it added £1 million to local tax for that little council with a budget of £10 million. That is outrageous. The Minister has said—and the Secretary of State has said it too—"Well, we are taking it away," but other things have been added, not only by his Department but by other Departments.
	The Secretary of State spoke with some glee about the local area agreement. It has been hyped as a new way of streamlining funding and reporting. I invited the Minister to come with me to a certain well-known Conservative council that he likes very much and that endears local government to him, and to listen to it independently on what this means to it. It means excess bureaucracy and time-consuming work. There are hundreds of pages of prescriptive guidance on process, on format—on all the agreements. It means minute scrutiny.
	I rang the council and spoke to the chief executive and some of his senior staff to ask whether the situation got better after my attempts to get the Minister to take notice and to reduce bureaucracy. The chief executive said, "No, it's worse. There are more mandatory indicators, all of which are based on national priorities and all of which effectively remove the so-called local aspects. Moreover, there are more than just the six-monthly reviews."
	The chief executive also said that he was looking forward to September, when the local government section of the Department will descend on him and his council. Little boys and girls just out of university and with no real understanding of life will descend on the council to tick it off and to tick various boxes. Rather than looking at actual outputs, they will be looking at process. That will cost the council a lot of money, and the situation will then be exacerbated by the gearing. An horrendous amount of time will be wasted, the costs will be ghastly and the gearing will exaggerate the process. If the Minister actually believed what he has been saying and got off local government's back, there would be a reduction in costs and a reverse gearing effect on council tax.

Alison Seabeck: This has already proved to be a highly emotive debate, which is indicative of just how important local government is to Members. Sadly, it has also been very predictable. It has clearly been a simple mechanism to enable the Opposition to run scaremongering stories, in the final week of the local election campaign, that have no foundation in fact. As chair of the all-party group on local government, that saddens me enormously. I would therefore like to focus on the positive aspects of the all-party group's work and on some specifics of the future of local government.
	The all-party group, supported by the Local Government Information Unit, is reviewing the possibility of enhancing the role of the councillor and of encouraging more people from diverse backgrounds to step up to the plate and seek election, thereby bringing with them a wealth of experience. We hope to feed our findings into the Roberts review being undertaken for the Department for Communities and Local Government. The future of local government depends in part on the quality of the people whom we attract as councillors. The stream of negativity from the Opposition today is hardly a good advert for the job.
	The all-party group heard from a range of witnesses—from councillors from all the main parties, from experts such as Professor Steve Leach, from Paul Wheeler of the political skills forum, from Dr. Stuart Wilks-Heeg of the university of Liverpool, and from those representing minority groupings. We also asked the media to participate. There is an enormous amount of enthusiasm from elected representatives who have submitted evidence on the role that they have undertaken, and for the innovative work going on within existing parameters to engage the public more widely, and to assist them in understanding the service that their council and councillors can offer.
	Interestingly and in contrast with today's debate, the all-party group meetings have been productive. It has been largely agreed on a cross-party basis that some of the problems flagged up tonight can be resolved only if we move forward in a more consensual and positive way. The view has also been expressed that the best authorities already make good use of existing powers to reach out to their residents and electorates. There is some excellent practice out there, and the Government's beacon council scheme certainly does an excellent job in highlighting best practice and disseminating information more widely.
	A number of Members have, through various early-day motions and private Members' Bills, supported the extension of local authority power and the wider empowerment of individuals in their relationship with their local council. The Local Government and Participation in Health Bill takes forward most of the key strands of the ideas being put forward and further enhances arrangements through local area agreements, for example, without some of the drawbacks of the measures proposed by others. The Opposition pamphlet setting out their position on sustainable communities raised concerns from experienced Members in all parts of the House. It suggested that local authorities should be given greater powers to set targets and to establish programmes directed at local needs, but quite how that fits in with proposals that would require Whitehall to deliver an action plan to achieve them I cannot imagine. Full cognisance does not appear to have been taken of the fact that local decision making means decision making within the locality.
	It is unclear how the Opposition's proposals would be achieved—how the mechanisms and the administration of their proposed scheme would be handled. Given their dislike for all things regional—and, by default, for regional offices—would they move this power and responsibility towards the centre? They have come up with few genuine proposals for the future of local government that stand up to scrutiny, and we have heard nothing new from them today. However, the Local Government and Public Involvement in Health Bill has managed to obtain broad support, and its passage through Committee was notable for the positive and often consensual debates that were held.
	That approach has been mirrored elsewhere. Lord Bruce-Lockhart, the Conservative chairman of the Local Government Association, welcomed the White Paper that preceded the Bill, saying that it reflected the growing confidence in, and competence of, local government, as well as the belief that the best way to deliver the best services to local people is at a local level. Front-line services should be focused on the needs of those who use them. Lord Bruce-Lockhart also acknowledged that the proposals would help to free up elected councillors to put local people first in the delivery of the right services at the right time and in the right place. Many of the witnesses to the all-party group have supported the view that the Local Government and Public Involvement in Health Bill is a real step in the right direction and that the challenge is there for authorities and individual councillors to grasp the opportunities presented to them.
	The Leader of the Opposition talks about taking responsibility and the avoidance of Government interference in other areas. He should, therefore, support what the Government are trying to achieve with local government. The Government want to release some of the central controls and to enable far greater control over decision making to be devolved to councillors and citizens.
	In his report, Sir Michael Lyons reaffirms the importance of local decision making and sees a positive future role for local government in fostering a new public confidence in our local governance arrangements. It is an incredibly detailed and thorough piece of work, as one would expect from Sir Michael. Although he dwells at length on a number of matters outside the question of taxation, Sir Michael does tackle the thorny issue of trying to find a solution to the perennial problem of local taxation.
	It would be in all our interests to resolve that problem once and for all and to accept that, at least in part, local taxation needs to be property based. No tax is popular, but every party in this House that aspires to being in government should want that problem sorted out in a way that at least enables local government to operate on a sound footing, plan long term and offer clarity to the taxpayer. The approach that I have suggested would also promote a greater sense of fairness and justice than currently exists.
	The Opposition have tried to imply that the Government want to introduce a waste tax in addition to the council tax, but that is merely further scaremongering. That proposal was simply one of the many options put forward by Sir Michael Lyons for consideration. Local authorities of all parties are looking at mechanisms that would enable the better management of waste. Some are using sticks and others carrots: for example, Conservative Barnet council has been targeting residents in respect of waste, and fining them. Which council can say that it would not want to use such a power in the future?
	When I sit through our debates on local government, I am always saddened to hear the unremittingly negative comments from the Opposition. They have yet to come to this House and offer any serious positive proposals that will help local government move forward. Hon. Members on the Opposition Front Bench could take lessons from those of their colleagues on the Back Benches who attend the all-party group. They contribute in a positive way, and understand the important contribution that local government and local councillors make to their communities.
	It may be that the Opposition's attitude to local government is still shaped by the 1980s and early 1990s, when local government was seen as a nuisance. It was the subject of swingeing cuts that caused morale among councillors to plummet, but the mood now is very different. Yes, councillors have been subject to inspection—but what a difference that has made. There has been an impressive turnaround in the number of authorities ranked as good or excellent—

Eric Pickles: Will the hon. Lady give way?

Alison Seabeck: Yes, briefly.

Eric Pickles: I thank the hon. Lady. I am the deputy chairman of the all-party group, and she has gone out of her way to thank me for my contribution. Will she therefore withdraw her remarks about the Opposition Front Bench? Or would she prefer to withdraw what she said about my contribution? She has to do one or the other.

Alison Seabeck: I shall be gracious to the hon. Gentleman, as his participation in the all-party group has been generally positive. In all fairness, I must say that he has made some useful suggestion and has enhanced the discussion.
	Local authorities have learned how to be self-critical, and how to seek out best practice elsewhere. They have gone from saying, "What can central Government, or indeed the public, possibly know about running a council? We know what we are doing," to saying, "Perhaps we can learn from others. Could we do a little better? Can you help us to improve our services?"
	The Government should be congratulated, as should the councillors and officers who have put so much effort into this transformation. My local authority, Plymouth city council, was close to being placed on special measures while it was under the control of the Conservatives. In order to get elected, they made rash spending pledges that took money away from core services, such as transport and waste disposal. On election, they frittered money away and made no attempt to put the authority on a sound financial footing. They still oppose green transport plans and only this week abstained on the urban strategy.
	The Labour administration, led by Tudor Evans, took the bull by the horns, dug deep to understand the true nature of the problems and took difficult decisions, showing real leadership. Plymouth is back on track and it has the lowest council tax in the south-west. Across the country there is clear evidence that local government is at last coming out its shell—under a Labour Government.

David Curry: I draw the attention of the House to my entry in the Register of Members' Interests.
	After listening to the speeches from the Front Benches, I realise that we are obviously all devolutionists now. However, if we are to be devolutionists there are two preconditions—a fixed idea of the direction of travel for local government on structure and on revenue. Until those two basic frameworks are in place, we cannot have an orderly, sensible and sustained process of devolution.
	We are in the middle of a new round of negotiations about unitaries. The Government seem to have stumbled into those negotiations and they need to make up their mind what structures for local government are available—I use that word deliberately. The truth is that we live in a centralised state at the moment and because we are trying to move towards a more relaxed system, devolution—or localism—will by definition be a managed process, so how we manage it is important.
	It is a question not just of local government structures but also of the configuration of all the other bodies whose responsibilities touch local government: the regional development agencies, the learning and skills councils, planning bodies and Government offices. The implications of devolution are huge in terms of the whole geometry of regional governance.
	The Government have been a bit all over the place. There was a period of enthusiasm for elected mayors, but then it was realised that impregnable Labour cities which it might take us several elections to have a go at in the normal course of events could fall at a single blow in a mayoral election when an outsider entered the race. Then there was the period of enthusiasm for universal unitaries, when the present Secretary of State for Environment, Food and Rural Affairs made a brief stopover at the Office of the Deputy Prime Minister as Minister of Communities and Local Government.
	We are now in the period of unitaries à la carte, so I am interested in where the debate on city regions will go. Representing my part of the world, I am a supporter of city regions and can see the logic in planning and skills terms of trying to treat as a whole not only metropolitan areas that abut one another but also the districts that supply that travel-to-work area.
	We want to know which direction the next regime will take. We have heard the contributions of the Chancellor's Yorkshire outriders, the Financial Secretary to the Treasury, the hon. Member for Wentworth (John Healey), and the Economic Secretary to the Treasury, the hon. Member for Normanton (Ed Balls)—I suppose they might be described as two of the horsemen of the Apocalypse.
	Capacity and accountability are important. The hon. Member for North Swindon (Mr. Wills) said that Swindon did not have the capacity to be a unitary. There is a real dilemma. The Government have insisted that we need more capacity in a number of sectors, so the health service has been reorganised to create more capacity. We were embarked on the creation of more capacity in police services, but the Government have withdrawn from that process. The dilemma is: to what extent do we trade off capacity for accountability? We are all legitimately concerned about the responsiveness of our institutions to the general public and about people's disengagement from the political process. However, if we unremittingly seek capacity as the sole good, the cost will be paid in terms of identity and accountability.
	I am sympathetic to the notion of the small unitary, because I want councils whose leaders can be recognised and accosted in the street, as happens in many French areas—it is well known that I have some sympathies for the way the French do these things. We recognise that accountability has a cost, but if we are to move through local authorities to devolve to the citizen, we must make sure that there are accountability structures. Whether we call it civil society or the third sector, the bodies in it may be very admirable but they are not necessarily representative. They are there to pursue a particular aim and we have to make sure that people speak for the wider community and not for particular interests exclusively.

Chris Mole: Far be it for me to suggest that the right hon. Gentleman is again showing up those on the Opposition Front Bench, but I genuinely believe that he puts his finger on one of the dynamics of public service—whether it be in local government or elsewhere—which is the trade-off between neighbourhoods and local accountability and the strategic capacity, efficiency and effectiveness of organisations. Given his wisdom and expertise in government, I would be really interested if he could give us his thoughts on how we might take the debate forward to ensure that we best resolve the problem without the usual yah-boo that seems to get in the way of addressing some of the challenges in local government.

David Curry: I am grateful to the hon. Gentleman for those remarks. I agree with him about the importance of the issue and I will certainly look for occasions to develop it if we are to put substance on our localism agenda. Meanwhile, if he is kind enough to pay attention to them, I will do my best in my columns.
	The second issue that is of concern to us tonight is funding. The present situation is not sustainable. Business rates are frankly off the agenda; I do not see anybody introducing them against opposition. I regret that, because they should be returned to local authorities. The circumstances that led to their nationalisation are past and there is a huge history now of working between business and local authorities. In fact, incorporating mechanisms that safeguard against abuse does not require a PhD. Relatively simple mechanisms can be deployed and I hope that we will move back to recognising that.
	Revaluation is also probably off the agenda. I rather regret the fact that the Government backed off that; they have rather backed themselves into a corner in doing so. I note the Secretary of State's little words "in this Parliament" and I look forward to the manifesto that says that if Labour is re-elected, it will reband and revalue in the next Parliament. I suspect that I will scan for some time before I identify that.
	The problem with charging is that people now find the council tax so highly objectionable that their tolerance for adding additional charges on top of that is not what it might have been a number of years ago. The council tax is more than ever centre stage, because nobody tonight has mentioned the fact that schools funding now goes directly to the schools. If one abstracts schools funding from the formula, one sees that council tax is getting on for half the revenue of some local authorities. It is a much more high-profile tax than it was. Redistributive business rates and council tax now form a huge element of the tax resources of local authorities.
	Of course, we need to explore the implications of the Lyons report. Even though Sir Michael has now gone to his earthly reward—although I am not sure that the BBC should be described as all that earthly—there are some substantial points in his report. The problem is that for years the Government said that they were waiting for Lyons, but he now says, "Sorry, the time is not ripe." It is a pity that we have an outstandingly good intellectual thesis that has not rescued us from some of our immediate dilemmas in the way that some of us hoped it might.

Paul Beresford: I am listening with interest to my right hon. Friend, but does he not agree that the accountability that he mentioned and financing are clearly linked? Because of gearing and the Government's paranoid desire for control, the difficulty with the current system is that neither of those two things are in balance. We cannot have accountability because the Government dictate, and the accountability has gone from the council tax because the gearing has exaggerated the cost of local services.

David Curry: I am sure that that is the case. On top of that, the Government, for reasons that we understand, wish to restrain the increases in council tax. Even if we do not have capping, the threat of capping has done that job and that has been used by both parties. I welcome the movement to two-year funding, and longer-term funding is clearly a sensible way to go.
	There is a problem for this Government and there will be a problem for an incoming Government. I would not want my party to come to office and then spend ages agonising over the same fruitless search for the north-west passage, which is the way through local government finance, that has preoccupied so much of this Government's time and no doubt would have preoccupied previous Governments' time. The fact of the matter is that there is no north-west passage—that is the problem. There is no pathway through the ice that is blocking the way. The return of business rates is not a panacea, given that the money is not a new source of funding, but it represents a more devolutionary way of applying the tax that creates more initiative.
	We should explore the idea of establishing a neutral agency for the distribution of grant. Such agencies are increasingly coming into fashion in other sectors of the public services. While we should explore the idea, rather than necessarily endorse it, both parties have an interest in finding a settled way to deal with the matter.

Chris Mole: Will the right hon. Gentleman give way?

David Curry: If the hon. Gentleman will excuse me, I have given way twice already and I am trying to finish my speech within my allocation of time.
	On structure and finance, local government needs some quality and stability, and at least predictable and defined directions of travel. Until we have that, the cries for devolution and localism will lack substance. If I may come back to my Francophile tendencies, I am bound to note that 3 May falls between the two rounds of the French presidential election. The turnout in the first round of that election was 85 per cent., but I suspect that we would be happy if we got half that turnout in a significant number of the councils being contested throughout the United Kingdom and, perhaps, in Scotland. The truth is that there is not enough at stake to make it worth while for people to turn out. People turn out when there is something at stake because power is the adrenalin of democracy. We need to put more adrenalin in our democracy.

Andrew Slaughter: During our debate on the future of local government, I thought that it might be helpful to consider a warning from history, albeit recent history. My local authority changed hands from Labour to the Conservatives just a year ago. I have suggested why that might have happened: partly through a deliberate deception—saying one thing and doing another—and partly owing simply to the absence of information. I do not remember seeing anything at all in the Conservative manifesto, which I have re-read, about the £34 million in cuts that the council is introducing across the board over the next few years. There are a few salutary lessons to be learned by anyone who is thinking about voting Conservative on 3 May, so I will run through one or two of them.
	The first thing that one gets is school closures of an especially perverse kind. Hurlingham and Chelsea school, which is a much loved and much improving school in Fulham, was told out of the blue last autumn that it would close. The council then set out to rubbish the school systematically by writing to prospective parents to tell them that they should not send their children there. The head teacher, who is a very mild-mannered man, wrote to the leader of the council last week to say:
	"the persistent misrepresentation of data has been a major fact in hiding the real context since your administration came to power".
	Despite marches and hundreds of representations, the council persisted with the closure.

Andrew Pelling: Will the hon. Gentleman give way?

Andrew Slaughter: Not at the moment.
	The fact that the council persisted with the closure meant that the matter had to go to the supposedly independent school organisation committee, but the council replaced members of that committee with people who they thought would vote in its favour. However, the council's presentation to the committee was so lamentable that even the people whom it had deliberately put on to the committee could not vote for the proposal. As a result, the proposal should have gone to the independent adjudicator today, but yesterday the council withdrew its proposal for closure. Although it gave no reason for that whatsoever, the reason is clear: there was no basis for the closure except for the fact that the site was valuable and the council wished to sell it off for capital gain. Despite all the hurt and distress that has been caused to children, parents and teachers, the council has made no apology. It has instead said that it will set up an independent commission, which will be an ill-thought-out body with no remit, chaired by a Tory peeress.

Eric Pickles: When I attended the annual meeting at which the council tax was set, I had the opportunity to speak to several Labour councillors, who blamed the hon. Gentleman for sowing the seed of these problems. Let me ask the hon. Gentleman a simple question: does he think that the Labour group was unwise to suggest that it would have delivered a lower council tax and cut the council budget deeper?

Andrew Slaughter: It is surprising that I know more about what was said at a meeting that I did not attend than the hon. Gentleman does about a meeting that he did attend. The only point that was being made is that it was not necessary to make £34 million-worth of cuts to front-line services in order to achieve a very small council tax cut; efficiency savings could have been made, instead. I can tell him that I do not meet anyone in the borough who does not think that they have had a raw deal.
	I visited the council's website the other day, on which nine people had allegedly said that they supported the council tax cut. I queried that, because the letters looked rather staged, and I got this response from the borough's chief executive:
	"Of the nine views posted on the 'Share your Views' area on council tax, all but two came from a vox pop done by press office staff on the streets of the borough, so there are no 'original' letters...The first two entries on the site were from emails forwarded to the council from"—
	the letter then names the hon. Member for Hammersmith and Fulham (Mr. Hands). The letter continues:
	"At the time of posting, there were no other comments received".
	So it appears that nobody supports the hon. Gentleman's position in the borough, and I am not surprised.
	To return to my brief, the second thing that happens under a Tory council is cuts to the voluntary sector. I have a separate Adjournment debate on that subject on Monday, so I will not dwell on it, but the thick end of £1 million is being cut from voluntary sector organisations, which include one of the best law centres in the country, organisations that support older people who are trying to get back into work, and organisations that provide for the single homeless. Opposition Members have supported many of those organisations in the past, and have sat on their management committees, but now the funding for all those groups is being cut by the Tory council.
	Thirdly, I should mention social care. The hon. Member for Meriden (Mrs. Spelman), who spoke for the Opposition, shed crocodile tears on that subject, and I have alluded to the increase in charging that the Conservatives in Hammersmith and Fulham had promised in their manifesto not to introduce. Hammersmith and Fulham Action on Disability, one of the voluntary organisations under threat, said:
	"Before the election when seeking votes, Conservative councillors undertook to sustain the no charging policy—but now they have found a way to erode it."
	Some 1,400 people described as having moderate care needs are at risk of losing all home care services because of the changing criteria. Kevin Caulfield, the chair of the coalition against charging, said:
	"We expect our council to lead on policy and practice that improves the quality of life of older and disabled residents—not introduce policies with poor consultation that will only result in increased poverty and isolation."
	The fourth result of a Conservative council is increased charging that far outweighs any cut in taxation. There has been a 25 per cent. increase in meals on wheels charges and there is a £6 charge for refuse sacks for recycling. The borough does not meet its recycling targets, but it will now charge people for the sacks that they need in order to recycle. When challenged on that, the council said that people had been misusing the sacks. They had been keeping them at home and not using them, and the charge was the solution to that problem. The council is looking to increase parking charges by 50 per cent., to £2.40 an hour. It has increased burial charges by 52 per cent. and it has even proposed to charge school governors for the police checks made on them.
	The fifth result of a Conservative council is an end to social housing programmes across the borough. There is also a change in housing allocation policies, and families are now being put into one-bedroom flats. As for those who happen to be made homeless, the council has even cut the grant that provides for the storage of people's furniture while they are looking for another property, so that furniture has to go, and there is very little chance of getting it back. Sixthly, there are cuts relating to environmental policy. Almost £1 million has been cut from refuse and street cleaning services. I have mentioned recycling; today I received a letter from someone who had asked the council why they could not recycle their kitchen waste. The council's response was that Government regulations meant that it could not take that waste. The person found that perplexing, as they live only 50 yd from Ealing, which does recycle kitchen waste, but I have already alluded to the honesty with which the local authority acts.
	Seventhly, I notice that there is a reference to library services in the Opposition motion, but those services are not free from attack either. The mobile library and the housebound readers' service have gone. The main reference library is being closed, and its specialist book collections are being dispersed and sold off. The council is also phasing out qualified librarians, because it does not think that it needs them at all.
	Policing is the eighth thing that suffers. The previous Labour council invested in extra officers and safer neighbourhood teams. The Conservatives have promised—another promise—24/7 neighbourhood teams, but the first thing they have done is cut three additional officers, which represents a 25 per cent. cut, from Hammersmith Broadway, the ward with the highest crime in the borough, which was the scene of a tragic murder only a month ago.
	I am not suggesting that all councils are like Hammersmith and Fulham, or that they are all quite as crackpot and doctrinaire in their behaviour. However, I make a plea to anyone who is thinking of voting for a Conservative council in May to heed the lessons of what the Conservatives do in office, rather than what they say they will do when they are trying to get into office. We have heard some erudite speeches about principles, but I suspect that when people go to vote on 3 May they will be most interested in whether their councils can provide reasonable taxation as well as the services that local communities demand. That is not being done—those services have been cynically cut in Hammersmith and Fulham—and it is a lesson that everyone should bear in mind.

Charles Hendry: The other thing people get with a Conservative council is a council that is re-elected with a bigger majority every time, because people are happy with the services that it provides.
	I want to focus on two issues: the raw deal that councils in East Sussex are getting under the Government's funding formula, and the erosion of powers that has prevented local councils from being able to make decisions on some of the most important issues that affect the people who live within their boundaries. First, there is a deep imbalance in funding for councils. I am often told that money is taken from the south-east and is given to Labour's marginal seats in the north, and there is clear evidence of that imbalance. We now have the facts. Of East Sussex councils, Wealden has the highest proportion of elderly people—certainly of the over-80s and over-85s—in the country, and that is partly why we have roughly the third lowest gross domestic product in the country. However, the grant per head that Wealden receives from the Government comes in at £54.03. The maximum level in the country is £133 per head, and even the average is £92 per head. If Wealden were funded at the average level for district councils, it would have a further £5.5 million a year that it could spend on local services or use to reduce council tax. It would increase its grant level by well over half.
	Another way of looking at it is to consider the proportion of council spending that has to come from council tax. If we look at the country overall, the average is 46.1 per cent., but the lowest proportion is in Exeter, where it is 21.6 per cent.—I am not sure what Exeter has done to be so special, apart from being a marginal seat—but in Wealden, it is 63 per cent. That is why council tax has been driven up so much: my councils do not receive the same level of grant as other authorities.

John Horam: rose—

Charles Hendry: I trust that my hon. Friend will forgive me if I do not give way, as I am keen that other colleagues should be able to make a contribution.
	If we look at the overall picture in East Sussex, the figures become even starker. If councils in East Sussex were funded at the average levels for metropolitan boroughs across the country, the county would have a further £113 million a year to spend on vital local services or to reduce council tax. There is tremendous anger about the fact that we are getting a bad deal, and my right hon. Friend the Member for Skipton and Ripon (Mr. Curry) is absolutely right that it is an issue that must be dealt with. The greatest frustration experienced by my local councillors stems from the fact that, every year, they are required to provide more services to the Government, but are not given the means of paying for them, so they have to find those funds from their own resources.
	Secondly, the Government have increasingly eroded local councils' ability to make decisions that they believe are right for local people. Housing was mentioned earlier, and it exemplifies the problem better than anything else. The current system is top-down. There is enormous anger in Wealden that hundreds of houses are imposed on us every year by people who do not know the geography of the area. That happens because of the way in which the process works. The anger is as much against the process as against the number of houses to be built.
	First, the Department for Communities and Local Government decides in consultation with the deeply unloved regional assemblies how many houses there should be in each county council area. The county councils then require the district councils to build a certain number. If the district council refuses to build that number, the decisions will be made by Ministers and their officials in Whitehall. The only thing that local authorities have to do is decide where they will find space for those houses. They cannot decide how many houses there should be, what type of houses they should be or, in many cases, their location.
	Even when local authorities say that there should not be more housing without investment in the infrastructure, they discover that they cannot get the funding for that. In Uckfield, for example, we have just one national health service dentist. We are facing the closure of the accident and emergency unit and the maternity unit at the hospital in Haywards Heath, which provides services to the town of Uckfield, yet we are still expected to build hundreds of houses in that town because of the formula.
	What we need is a new approach whereby local councillors, elected directly by the people whom they serve, are able to make decisions on how many new houses there should be, where they should be built and what type. It is the Government who will not allow them to make those decisions, and who are forcing them to follow the existing procedures against their will.
	I have deliberately kept my comments brief as I know that other colleagues wish to speak in the debate. In her opening comments the Secretary of State said that the Government should be judged on their results, not their rhetoric. We will indeed judge them on their results. They have fiddled the system of funding local authorities, which has made matters infinitely more difficult than they should be. They have undermined local decision-making, and they will be truly judged on 3 May.

Bob Neill: I, too, shall try to be brief. The House will note my interest as a member of the London assembly.
	I shall deal with two issues. I was grateful to hear the observations of my right hon. Friend the Member for Skipton and Ripon (Mr. Curry) and I agree with every word. In particular, he touched on the issue which neither Lyons nor much of the debate has yet touched on—the need for us to consider the balance not just in funding, but in competencies, between central and local government.
	Like my right hon. Friend, I have some knowledge of local government in France. The turnout figure is a point at issue, and that applies at local level as well. It is not insignificant that if one takes the average for all local authorities in the United Kingdom, 60 to 70 per cent. of total budgets come from central Government, whereas in France about 25 per cent. on average comes from central Government and about 45 per cent. is raised locally.
	One thing that Lyons got right was to identify a weakness under our current arrangements whereby local authorities are unduly dependent on one single variable source of taxation in the council tax. It is right that there should be a significant element of property taxation in the portfolio, but having identified that, Lyons ducked the issue of what other areas of discretionary spend we could put in the local government armoury. That is my second point.
	One of the great frustrations associated with local government is the difficulty of attracting people—

Martin Horwood: Will the hon. Gentleman give way?

Bob Neill: Time is very short. I hope that the hon. Gentleman will forgive me if I make a little progress.
	One of the reasons why people do not get involved in local government or vote at local council elections is the belief that local government has very little discretion. That has been made worse under the current financing regime by the extent of ring-fencing. The evidence demonstrates that about 50 per cent. of the funds that come from the centre to local government are ring-fenced. Back in 1997-98 that was 4.5 per cent. Steps could be taken immediately to reduce the amount of ring-fencing, in the same way as we should be reducing, as has already been said, the level of controls and the targets culture, which impose a considerable burden.
	I would go further. I take the view, as my right hon. Friend the Member for Skipton and Ripon said, that the time has come when we should consider, with certain safeguards, returning the business rate to local authorities, not least because there is a need to encourage them to broaden their tax base. When I was a local councillor, there was almost some positive competition among London boroughs to encourage business to have more commercial development in the local authority because we gained benefit to our tax base. It would be healthy for us to look at that once again. In the same way, if we follow that localist path, perhaps we must accept that we should think again about capping.
	Those are the big points that we need to look at, and a lot more work needs to be done on that. I come now to a specific point—

Martin Horwood: The hon. Gentleman said that Sir Michael Lyons did not suggest any alternatives, but he quite clearly did. At paragraph 7.239 he suggested that local income tax was a perfectly viable alternative.

Bob Neill: We all know what Sir Michael Lyons said on that. I note that the hon. Gentleman did not quote his own spokesman, the hon. Member for Twickenham (Dr. Cable), who said that double income earners, of whom there are a particularly large number in my constituency, will be worse off under that, and that people would start getting hit at about £30,000 plus per annum.

Stephen Pound: The hon. Gentleman has two incomes.

Bob Neill: I give the hon. Gentleman credit for a little more wit from the Labour Benches than we have had from those below the Gangway today. It does not make him right, but at least it is amusing.
	I leave the Minister with one specific problem that we find in Bromley. The Minister knows that he has at least achieved one part of the Government's amendment in relation to Bromley—he has brought it stable funding. It has been at the floor in terms of grant settlement for the past six years and it has consistently had the second lowest level of formula grant support in London for the past six years. That is not a stability that we would welcome, but a peculiar circumstance arises from it. Because it is a floor authority but has considerable demands for capital expenditure for education purposes, it is denied access to the supported capital expenditure revenue element of funding that comes from the Department for Education and Skills. So we are in the peculiar situation that, even if we could borrow under the prudential regime, there would not be any central Government funding to pick up the borrowing costs and we would then have to dip into revenue costs to cover that, which would push us even tighter against our settlement because of being at the floor. I suspect that that is an anomaly, and unless the Minister can come up with some explanation, people in Bromley will feel greatly aggrieved about that.
	I have deliberately cut my remarks short. I hope that I have dealt with both a matter of principle and a local issue, and that the Minister will be able to assist on both those points.

Andrew Pelling: I will keep my comments short as I know that another Back-Bench Member wishes to speak.
	The upcoming local elections represent the 25th anniversary of my holding elective office, most of which time has been in local government. But perhaps the debate has not changed very much during those years. In many ways, I wonder whether the Lyons report will end up adding much more than the Layfield report did in terms of changing local government finance.
	In many ways, much of this debate could have been repeated 25 years ago, and I am not sure whether we add much to debate when we get involved in ritual condemnatory remarks about one particular local authority or another.  [Interruption.] I do wonder whether the hon. Member for Ealing, Acton and Shepherd's Bush (Mr. Slaughter), who speaks so often about Hammersmith and Fulham, ever debates any other subject in the Chamber.

Andrew Slaughter: rose—

Andrew Pelling: I shall speak for only a very short time.
	Such is the diffusion of power away from local government that there is little value in trying to pin blame on one local authority or another in terms of performance, bearing in mind the fact that so few powers are given to local government in any case.
	It is welcome that the number of targets for local authorities have been reduced from 1,200 to 200, but that is still far too high a number if we are to believe that there is real discretion for local authorities.
	There must come a time for some change in local government finance. With all the nationalisation that has taken place in local government provision, the quick and dirty approach will be to take much of those funding flows that in reality are national expenditures and to leave far more of the overall budget left for local authorities in the control of local authorities so that there will be much greater accountability.

Peter Soulsby: Thank you, Mr. Speaker, for allowing me to speak, albeit rather briefly, at the end of the debate.
	I was not intending to contribute, but three elements of the speech by the hon. Member for Meriden (Mrs. Spelman) prompted me to do so. First, she failed to explain precisely what is Conservative policy with regard to the funding of local government. She told us very eloquently what she and her party are against, but did not explain what they are in favour of or what they want to replace the council tax of which she was so critical.
	Secondly, the hon. Lady failed to explain why revaluation would of itself lead to higher council taxes or how the total amount paid could somehow be increased by the process of revaluation. It would of course inevitably lead to some paying more, but, equally, to some paying less.
	Thirdly—this element most prompted me to get to my feet—the hon. Lady accused the Government of making local councils mere agents of central Government. As somebody who was a council leader for a considerable proportion of the Thatcher and Major years, that accusation seemed pretty rich coming from the Conservative Benches. During those years as council leaders, my colleagues and I did our best to protect the most vulnerable in our communities from the devastation that the Tories caused to the services that we were providing on their behalf. I was well aware of the reality behind the Conservative commitment to local democracy. The reality was savage cuts in services, massive job losses and the devastation of the morale of members and officers in local government—and, of course, the poll tax.
	The Government have much more to do to repair the damage that was done during those years. I wanted them to go further and faster, but I recognise that they have at least begun the process of rebuilding local leadership, of rebuilding the investment in local people, and of re-empowering locally elected representatives. I welcome the steps that have been taken. Local government and the political parties, at local and national level, need to respond to the challenge and to play their part, particularly in encouraging and enabling good-calibre candidates to stand for local government.
	We must not forget that local government and local democracy are too important to the well-being of our society to be allowed to wither, and certainly too important to return to the denigration and devastation of the Tory years.

Eric Pickles: We have had a good debate that has ranged widely from reorganisation to ring-fencing. We heard a particularly elegant speech by my right hon. Friend the Member for Skipton and Ripon (Mr. Curry) about the balance between capacity and accountability. I seek some clarification from the Minister on the "à la carte" nature of the restructuring.
	The Government are conducting a review of local government in several English counties, but I am not clear what authority they have to do that. Last Wednesday in a Westminster Hall debate, I had an opportunity to ask the Under-Secretary of State, the hon. Member for Basildon (Angela E. Smith), that very question. I said:
	"I have a simple question. What powers is the Minister relying on to make these deliberations?"
	She replied:
	"Powers in the Local Government and Public Involvement in Health Bill that is going through Parliament."—[ Official Report, Westminster Hall, 18 April 2007; Vol. 459, c. 94WH.]
	She then suggested that I was well aware of that.
	I believed that procedures already existed to change the structure of local government. Indeed, they do. The authority for annual review of local government is set out in the Local Government Act 1992. Section 13 states that the Secretary of State may request the Electoral Commission to undertake a review, which in this context means
	"the replacement in any non-metropolitan area, of the two principal tiers of local government in a single-tier".
	Section 17(1) states that structural changes can be effected by order of the Secretary of State on the recommendations of the Electoral Commission. In the case that we are considering, no request has been made to the Electoral Commission and, consequently, no recommendation to consider the structural changes.
	I am not aware of any other powers that the Secretary of State has to initiate such a massive task. I know that, after the Budget, we passed special resolutions that any change in tax, rates or duties would have immediate effect. I cannot recall the House passing any special resolutions to enable the Secretary of State to introduce the review. I am confident that the Under-Secretary would have mentioned them had that been the case.
	We are not considering an academic question, because local authorities have spent hundreds of thousands—perhaps millions—of pounds preparing for the review. They are responsible to their residents, who will look to them for the authority for expending that money. To have lawful authority, both Houses of Parliament and Her Majesty must agree. A draft law and a law in progress is not enough. Will the Minister for Local Government clearly set out the authority so that we can all understand it?
	I am delighted to see the Secretary of State in her place. She suggested that she sought to pull back the powers to restructure. I respectfully remind her that the Local Government and Public Involvement in Health Bill has not returned to the House. Is she giving an undertaking to table an amendment on Report?

Ruth Kelly: Yes.

Eric Pickles: That is fantastic; I would call that a result. We look forward to the measure's return to the Floor of the House. If the information is correct, we may well look out for it.

Alistair Burt: We might indeed.

Eric Pickles: Yes.
	My hon. Friend the Member for Meriden (Mrs. Spelman) made a moving speech about the sub-class of pensioners that is being created and the reduction in take-up of council tax benefit. She also emphasised that two thirds of councils report losses in NHS funding and have to make up the shortfall.
	My hon. Friend the Member for Mole Valley (Sir Paul Beresford) spoke with great eloquence about the impact of the comprehensive performance assessment on his small local authority. He also referred to a visit by the hon. Member for Hazel Grove (Andrew Stunell). As a councillor, I also appeared before my hon. Friend and I always found him to be charming and most courteous.
	My hon. Friend the Member for Wealden (Charles Hendry) spoke eloquently about the plight of his council and talked movingly of the deprivation in his constituency.

Andrew Stunell: rose—

Eric Pickles: I hope that the hon. Gentleman will not say that my hon. Friend the Member for Mole Valley is not a charming person.

Andrew Stunell: I certainly would not say that the hon. Member for Mole Valley was anything other than charming, but did the hon. Member for Brentwood and Ongar (Mr. Pickles) get a result when he visited his charming colleague?

Eric Pickles: Oh, I did—I always found that my hon. Friend delivered.
	My hon. Friend the Member for Croydon, Central (Mr. Pelling) spoke about greater accountability and wondered whether Lyons and Lichfield would end up as the same thing. At least there is a possibility of a BBC documentary about the Lyons report.
	The hon. Member for Leicester, South (Sir Peter Soulsby) asked what evidence we had that revaluation would increase the council tax. The answer is Wales, where 33 per cent. of households went up a band and only 8 per cent. went down. He criticised the suggestion that the local authorities have become the agents of Government, but the right hon. Member for Norwich, South (Mr. Clarke) originally made it. If the hon. Gentleman has problems with that, he should take it up with his party.
	The hon. Member for Hazel Grove was a little disingenuous. At least his predecessor admitted that the redistribution effect of equalisation—having a slightly higher local income tax in one part of the country to pay for another—could be a problem. The hon. Gentleman appeared to suggest that that was not the case. With only a week to go before the local elections, I thank him for making it clear that the Liberal Democrats oppose offering special help to pensioners. I will ensure that that appears in our last-minute leaflets to make it clear that the Liberal Democrats have abandoned elderly people.
	The hon. Member for North Swindon (Mr. Wills) was very kind about Conservative control in his area, suggesting that everything was right in respect of ring-fencing and central control, but his argument was eloquently demolished by my hon. Friend the Member for Bromley and Chislehurst (Robert Neill).
	The hon. Member for Plymouth, Devonport (Alison Seabeck) was too nice about me for me to criticise a single thing that she said, but I have to say to the hon. Member for Ealing, Acton and Shepherd's Bush (Mr. Slaughter) that every time he speaks about Hammersmith council I know exactly what the wedding guest felt like in "The Rime of the Ancient Mariner".
	The Secretary of State made an interesting point but was rather unkind about Trafford. I took the opportunity to look into all the metropolitan district councils surrounding Trafford—and guess which authority had the lowest council tax? [Hon. Members: "Trafford."] Yes, Trafford, and guess which party controls Trafford? [Hon. Members: "The Conservatives."] Yes, and all the others have levied vastly higher council tax bills.
	The Secretary of State went on at some length about all the questions that we have been asking, suggesting that we were scaremongering about a new way of raising council tax and revaluation. Indeed, the Minister for Local Government got rather upset about it all. Yes, we have tabled a number of parliamentary questions and we have taken the opportunity to use freedom of information legislation. We know that the Government are looking into computer-assisted mass appraisal and automated valuation models and that they have spent the best part of £500,000 buying in bulk cameras for their inspectors to have a look at various things.
	We also know—the House may be interested in this—that the council tax inspectors in the Valuation Office Agency have been holding high-level talks with local tax inspectors in Hong Kong. That gives a whole new dimension to a Chinese takeaway. The talks included a summit at Hong Kong's new Disney resort on the logistics of holding annual council tax revaluations.
	As my hon. Friends will testify, I have always been of a romantic disposition, dreaming in my youth of far distant places. In my early years, I was much taken with the book "Beau Geste", and felt that to see the world, a period of recruitment into the French foreign legion was the thing to do. I see now that I was wrong and that the Valuation Office Agency is the place for exotic travel, taking in Disneyworld and Hong Kong. Admittedly, unlike in the foreign legion, in the Valuation Office Agency one is unlikely to be shot at by Tuaregs or the Vietcong, but there are other discomforts. The air conditioning in some of the five-star hotels can be a little tricky after one has spent the day talking to Mickey Mouse. There is surely no distance that the Government will fail to travel in order to rob pensioners of their savings.
	There is one sure test that shows how proud Government supporters are and how much they want to win in May. Are they prepared to be associated with Labour policies? Are they prepared to put their names on the ballot paper? Are they prepared to wear the party's colours? We all know where the Conservative party stands. We are standing in a record number of seats—90 per cent. of all the contests have a Conservative party candidate standing, and it is even higher in some regions. The Liberal Democrats are just treading water, but the Labour party has gone backwards, contesting not far short of half the seats in the election. That is the lowest number of seats contested by any Government party at a local election. It is the clearest indication that no one trusts this Government. Nobody believes that their policies are working and their closest supporters are too ashamed of Labour's record in local government to wear a red rosette.

Phil Woolas: I congratulate the hon. Member for Brentwood and Ongar (Mr. Pickles) on the flourish at the end, which has done for local government policy what George Best did for the soft drinks industry—not much at all. I congratulate him on the flourish, but what is clear from the debate is that the traditional stance of the Conservatives in opposition is not to have a policy. We know that they do not have a policy, because they have not said anything positive in debates over the last two years. We know that it is the job of Her Majesty's loyal Opposition to oppose Government policy, and we expect them to do that, but if I were Her Majesty, I would want my money back, because they have failed to do it effectively.
	The Conservatives are not stopping at opposing our policy, however. They are engaging in a rather dangerous and disingenuous campaign of misrepresenting the Government's policy. They are misrepresenting the Government's policy, and they know that they are doing so. The comments made by the Government in debates in Committee on the Local Government and Public Involvement in Health Bill—which my hon. Friend the Member for Plymouth, Devonport (Alison Seabeck) rightly observed was a consensual Bill—have not been passed to the Conservative Front-Bench spokespersons who have been speaking tonight.
	On restructuring, the Government asked councils whether they wanted to put forward proposals to move to unitary structures. It has already been pointed out that half the councils that have put forward proposals are controlled by the Conservatives. These are not proposals from the Government. They are the result of a devolutionary approach to restructuring, which stands in stark contrast to the approach taken by the previous Conservative Government, who imposed unitaries on Scotland and Wales without so much as a proper consultation, and who introduced changes following the Banham review, after a helicopter flight by the then Secretary of State, Michael Heseltine, with an Ordnance Survey map and a felt tip pen—his words, not mine. The idea that the Government are putting a gun to the head of councils and threatening to withdraw resources is a scandalous accusation, and it is not true. I understand that there are local elections going on, but I wish that the Conservative party would keep the arguments at local level and not pretend that the proposals are those of the Government.
	The power to direct has been agreed with the Conservative-led Local Government Association on a cross-party consensual basis. The commitment has been given to the Committee considering the Local Government and Public Involvement in Health Bill and to the House by the Secretary of State that that will be the case, yet the myth that it is not the case is perpetuated.
	The revaluation issue is the entirety of the Conservatives' policy. Again, it is based on what is frankly a misrepresentation, and they know it. They say that the Government are proposing new powers for inspectors; we are not. The powers of inspection were laid out in 1991 by the then Conservative Government who introduced the council tax. The law does not allow an inspector to enter someone's home without the permission of the householder. There are no plans to change that, and the Conservatives know it.
	The Conservatives no longer have a policy to engage in a constructive debate about the future of local government. Instead, they opportunistically attack the Government on the basis of misrepresentations. At least the right hon. Member for Skipton and Ripon (Mr. Curry) took us into a proper policy debate, because he understands local government finance, as I suspect some of his colleagues do not.
	I shall apply myself in a moment to some of the serious policy points that have been made, but before I move off my criticism of the Conservatives' attack, their strategy and their tactics, let me issue a warning to them. It is a warning that was sounded by my hon. Friend the Member for Ealing, Acton and Shepherd's Bush (Mr. Slaughter). In the 1980s, the Thatcherite councils in Wandsworth and Westminster were seen as flagships—

Stephen Pound: And Bradford.

Phil Woolas: And Bradford, as I am being reminded. How could I forget? I tend to keep my criticisms of Bradford less public.
	In that period, there were two flagship Thatcherite authorities which the leadership of that Government—particularly under Kenneth Baker, now Lord Baker—used to drive policy changes through the Conservative party. People now face not a flagship but a U-boat, because Hammersmith and Fulham council is the true face of the Conservative party at local level. Let me give some succour to my hon. Friend the Member for Ealing, Acton and Shepherd's Bush: the arguments from Hammersmith and Fulham council and the hon. Member for Hammersmith and Fulham (Mr. Hands) for extra resources cut no ice against the background and the eight policy measures explained to us.

John Redwood: Will the Minister give way?

Phil Woolas: No, I will not.
	The accusation repeated tonight that the Government distribute formula grant on the basis of party political bias is scurrilous and a misrepresentation. It is not backed up by the facts, by the figures provided independently by the House of Commons Library, or by the Local Government Association's policy. I give the warning about the U-boat of the Conservative party at local level, because millions of voters on 3 May will look to Hammersmith and Fulham council for an example of what would happen were they to be taken in by the scaremongering of the Conservative party and its supporters in the press.
	At least the hon. Member for Hazel Grove (Andrew Stunell) has a policy that we can debate. I disagree with that policy, because local income taxes, as my hon. Friend the Member for North Swindon (Mr. Wills) said, would require a redistributive amount that would diminish the local discretion sought. The idea of localisation of business rates ignores the reality of the direct support grant, the changes made in the past 10 years and the £1 billion extra provided through the local authority business growth initiative scheme, which is welcomed by councils across the political spectrum.
	The Liberal Democrats claim that their policies are original and sound, but the problem, as a predecessor said, is that when they are original they are not sound, and when they are sound they are not original.  [Interruption.] It might be old but it is still true; at least the hon. Member for Hazel Grove knows the origin of the quote, which is more than can be said for some other Opposition Members, who should know it.
	My hon. Friend the Member for Plymouth, Devonport, as chair of the all-party local government group, made a thoughtful speech. She praised the direction of travel through local area agreements and the duties to co-operate in the Local Government and Public Involvement in Health Bill.
	My hon. Friend the Member for Leicester, South (Sir Peter Soulsby), who brings huge experience to the debate, said that he welcomed the direction of travel and would like to go further.
	The hon. Member for Croydon, Central (Mr. Pelling) spoke on behalf of his council and made some important policy points, as did the hon. Member for Bromley and Chislehurst (Robert Neill). We have debated previously the distribution of grants and how that affects his area.
	My hon. Friend the Member for North Swindon brought to our attention some important points about what has been happening in Swindon. I give him the assurance that he requested: the improvement that has taken place in Swindon council has in significant part been as a result of the strategy of council improvement backed up by real money from central Government. I hope to make that point in Swindon next week.
	The hon. Member for Mole Valley (Sir Paul Beresford) gave me some good advice on twisting the Liberal Democrat graph, and I shall examine his points. I disagree with him, however, on his criticisms of local area agreements. There is broad and deep consensus on the idea of joining up funding at local level, and of changing the performance regime. The Government have put huge extra resources into local councils, which have seen improvements in services, and are creating a regime of devolution.

Patrick McLoughlin: rose in his place and claimed to move, That the Question be now put.
	 Question, That the Question be now put,  put and agreed to.

Question put accordingly, That the original words stand part of the Question:—
	 The House divided: Ayes 160, Noes 329.

Question accordingly negatived.
	 Question, That the proposed words be there added,  put forthwith, pursuant to Standing Order No. 31 (Questions on amendments) : —
	 The House divided: Ayes 274, Noes 200.

Question accordingly agreed to.
	Mr. Speaker  forthwith declared the main Question , as amended, to be agreed to.
	 Resolved,
	That this House notes the transformation in local government since 1997 and the dramatic improvements in performance across a wide range of front-line services; recognises the achievements of local authorities and their staff with a record number of authorities awarded three or four stars for their performance by the Audit Commission in 2006; contrasts this with the underinvestment and poor morale that the Government inherited in 1997; applauds the Government's radical and devolutionary local government White Paper as the next stage in the reform of local public services, strengthening local leadership and partnership working and empowering local communities; believes that the measures set out in the Local Government and Public Involvement in Health Bill will strongly promote sustainable communities, improving local environmental quality and the quality of life of local residents; congratulates the Government on the way in which it is providing stable funding for local government, increasing overall grants to councils by 39 per cent. in real terms since 1997 with the average council tax increase in England at 4.2 per cent. for 2007-08; and therefore supports the Government in implementing the White Paper and the Bill.

EUROPEAN COMMUNITY DOCUMENTS

Conservation of the European Eel

Motion made, and Question put forthwith, pursuant to Standing Order No. 119(9)(European Standing Committees),
	That this House takes note of European Union Document No. 13139/05, Draft Council Regulation establishing measures for the recovery of the stock of European eel; recognises the long outstanding need to conserve and enhance the European eel stock; and approves the Government's intention to vote for the adoption of this proposal, provided it makes suitable provision to allow for the restocking of glass eel to European inland waters.— [Claire Ward.]
	 Question agreed to.

Aviation Agreements

Motion made, and Question put forthwith, pursuant to Standing Order No. 119(9)(European Standing Committees),
	That this House takes note of European Union Document No. 8656/06, Draft Decisions on the signature and provisional application and conclusion of the air transport agreement between the European Community and its Member States, on the one hand, and the United States of America, on the other hand; and endorses the Government's approach to discussions on this document. —[Claire Ward.]
	 Question agreed to.

ADJOURNMENT (MAY)

Motion made, and Question put forthwith, pursuant to Standing Order No. 25 (Periodic adjournments),
	That this House, at its rising on Thursday 3rd May 2007, do adjourn till Tuesday 8th May 2007. —[Claire Ward.]
	 Question agreed to.

DRAFT CLIMATE CHANGE BILL (JOINT COMMITTEE)

Resolved,
	That this House concurs with the Lords Message of 23rd April, relating to the Joint Committee of Lords and Commons appointed to consider and report on the draft Climate Change Bill, presented to both Houses on 13th March (Cm. 7040), that—
	(1) the Committee appointed by this House do meet the Lords Committee as proposed by their Lordships; and
	(2) notwithstanding the Resolution of 18th April, it be an instruction to the Joint Committee on the draft Climate Change Bill that it should report by 25th July 2007. —[Claire Ward.]

PLANT SCIENCE AND CLIMATE CHANGE

Motion made, and Question proposed, That this House do now adjourn.— [Claire Ward.]

Ian Gibson: It is a pleasure to talk tonight about plant science and climate change because, in some ways, climate change has become the media story of the decade. Although there is a tendency to overblow some of the claims of what might happen, most of us accept that things will happen and that they are beginning to happen. I want to address that.
	We see the effects of climate change all around us. In a funny way, I often think about Vivaldi's "Four Seasons", which could become three seasons. That would be quite a revolutionary change in classical music. We look at the papers and see reports of snow-less ski slopes and flowers blooming at all the wrong times throughout the winter. That is not something that just happens on the equator or elsewhere; it actually happens in this country as well.
	When it comes to combating climate change, things are not as simple as they appear. Research recently and a great deal of column space has been devoted to talk about air travel, carbon emissions and carbon offset schemes. People argue scientifically that some of those schemes might not do what it appears that they would do. Recent research from the Lawrence Livermore laboratory in the United States and the Carnegie Institution at Stanford university in California suggests that planting trees to offset carbon emissions could contribute to global warming unless the trees are planted in the tropics. That is an interesting new aspect that we had not thought about. It is only research and more needs to be done, so I guess that what I am saying is that there are no quick fixes when it comes to climate change, but we have to adopt and develop the policy of planting trees, whether they are in the tropics or elsewhere.
	The rule of no quick fixes also applies to the first generation of biofuels. Although the need for zero-carbon fuels is obviously real and present, the deforestation of developing countries taking place in the rush to make way for biofuel plantations is having a more severe effect on the planet than many of us imagined. It is argued that the carbon emitted by burning the trees and the peat to make way for biofuel crops far exceeds any savings that one could hope to make from burning renewable fuel instead of petrol. A further side effect is the destruction of many natural habitats and ecosystems as developing countries struggle to get into the new market, effectively throwing environmental concerns to the wind. Interesting questions in this area still need to be resolved, despite the fact that we acknowledge that climate change is taking place.
	If we look at this complex issue closely, we find that our mission is to consider not only how to prevent global warming, but how to deal practically with its consequences in the United Kingdom. We must ensure that we enter the 21st century with secure energy and food supplies. If we are to find the solution, we must examine the science that is being developed with plants in this country. We cannot look abroad for the solutions to our energy problems. We should be implementing schemes that will enable us to be responsible for what happens in the UK by concentrating our efforts on a second generation of bioenergy crops that use biomass.
	Biomass in itself is just a source of energy production along with other renewable energy sources, such as wind, wave, geothermal and sunlight. Miscanthus, switch grasses and willow and poplar trees can all be grown in the UK to contribute to the biomass initiative. Their growth requires less land than existing biofuel crops. They are renewable and carbon-neutral. They do not require the volume of chemicals and pesticides that have led to the criticism of crops such as rapeseed.
	Short-rotation coppice willow is being grown at Rothamsted Research. The crops grow on marginal land of low quality and require little input. If such second-generation bioenergy crops were grown on 350,000 acres of UK land and processed to produce fuels such as diesel, some 7 per cent. of the UK's petrochemical needs would be met without reducing food production and with very little input. While such plant development is important, we need more research. It is welcome that the Biotechnology and Biological Sciences Research Council has put £20 million into that research.
	We face a situation in which before the research has been done, many countries and companies are planting vast areas of biofuels. I argue that that will damage the environment. If we are able to produce more bioenergy crops in the UK, we will be able to control the way in which they are farmed and regulate the carbon dioxide that is emitted. We could reduce the carbon dioxide emitted by the transportation of imports. In that way, we would guarantee our energy security, which is a real problem that relates to the sources of our energy production.
	It is almost certain that there will be competition for farmland between biofuel companies and the food industry. Our main concerns will be reducing carbon emissions and ensuring that we have effective farming systems. Bioscience offers us the possible solutions that we need.
	As the climate warms, it will be almost inevitable that we will witness further physical changes to the UK countryside. That will have a massive effect on farming in this country. Arable farmers will need crops that can grow and be harvested under variable temperatures and rainfall. For example, it is predicted that the average temperature in East Anglia will have risen by 3° C by 2050. It is no use George Bush telling us that we will reduce global warming by talking in terms not of Fahrenheit but of Celsius, even though the numbers are obviously reduced. There will also be greatly reduced rainfall and much more water evaporation and carbon dioxide in the atmosphere.
	The climate can affect the length of a harvest and soil structure, which vary massively even from year to year. Owing to global warming, farmers will face new infections and parasites. Wetter winters will make cereal crops more prone to fungal diseases such as Fusarium ear blight. We will simply not be able continue to grow the variety of crops that are traditionally grown in the UK.
	There are a number of ways to approach the problem. The rising temperatures will lead to a lot of drought, and in East Anglia, yields of sugar beet are expected to decline by half in areas that are already experiencing those difficulties. We can increase rainwater catchments, and irrigation efficiency; those are practical starting points, but we must also look into the genetic make-up of plants that can survive in extreme climates. We are really gifted at such work in this country; we have centres such as Broom's Barn, Rothamsted and the John Innes Centre in Norwich, which are tackling the problems of developing drought-resistant sugar beet. We can now isolate the genes that allow plants to cope with extreme temperatures. Those genes can also be bred into commercial crop varieties.
	We can protect cereal crops from fungal diseases by introducing genes with a natural resistance. Scientists at the John Innes Centre in Norwich have isolated several genes that decide whether a plant needs a cold period before it will flower. The traditional teaching is that there has to be a cold period before an explosion of flowers will appear. There is a cold trigger that can be bred in and out of plants to produce winter and spring varieties, and it varies; that occurs in plants in Spain, Sweden and in this country, and we are learning how that happens. That technology will become really important as temperature changes take place. Crop protection is another important subject to consider. All our farmers, including organic growers, rely on plant protection products of some kind. As biofuels and food compete for land, we will only meet the increasing demand for both if we ensure that more crops make it to the harvest stage, through the responsible use of pesticides and effective land management.
	Plant science has a central role to play in all our futures, and in combating climate change, and we miss its importance at our peril. It is sad that job losses are occurring in places such as Rothamsted, which had a net reduction of 17 members of staff in 2005-06. The John Innes Centre is absolutely world-class—the best in Europe—and it produces research that everybody admires; I mentioned just some of it—the research about flowering and the genes involved in it. I am talking not just about genes that make better-looking plants, but about genes that are commercially important.
	How long will we be at the forefront of plant science if we do not make the necessary investment and address the fact that people are not entering the profession? Many young people do not see that plant science is really quite an appetising profession. We have to link up that kind of science with innovation and public benefit. As you will know, Mr. Speaker, I am also actively interested in biomedical sciences and biomedical research, for which a plethora of research and development funding has been made available by the Government, charities and the pharmaceutical industry. We may bemoan the conditions that those sciences face, but they are nothing like as bad as the what is happening in the plant sciences. There is one research council involved in plant sciences, the Biotechnology and Biological Sciences Research Council, and only one charity involved in plant science, the Gatsby Charitable Foundation, which was set up by the former Minister for Science and Innovation, Lord Sainsbury of Turville.
	We have to acknowledge that the plant-breeding industry in this country has been affected by the genetically modified crops debacle and the "anti" attitude of the public. In the House, too, people were against GM crops and fought against them, and that has caused people in the industry to leave the UK and go elsewhere to develop their talents and the new sciences. We get £336 million in funding a year, but a glance at the title of the Biotechnology and Biological Sciences Research Council—the body that gets that kind of money—shows that it has many other areas on which to spend that money, including biotechnology, another area that has a world-class dimension to it. Plant science always falls down the list of priorities.
	It is important to establish the industry in this country. BP is setting up a $250 billion biofuels research centre in California, rather than in the UK. That is really strange to me, given the scientific expertise that we have. It was Schwarzenegger himself who agreed to match the investment, while the research council could offer only £20 million. It is sad that that has developed in the States, as it could have developed here.
	While the UK has very good plant-breeding technology, our ability to use that knowledge is extremely vulnerable. It is regarded as underfunded and unsexy, in fact, by many young scientists, and I have attended many meetings at which young people have said they do not want to go into plant research, because there is no money or career structure. We need to develop plant varieties that are specific to the UK's climatic and social needs. The multinational plant-breeding companies are willing to do so, and it will help us with our food and fuel security, but we must make them regard it as a priority to be developed in the UK with the backing of our proud and talented researchers.
	The Government, too, must start to think about plant sciences and practical solutions to climate change that they can develop to provide energy, resistance to diseases and so on. Things are going to change, and we cannot wait 20 years. We must accept that it is going to happen. Malaria is likely to come to this country, but many plant diseases will come here, too, and we should research them now. We have to get the agricultural community behind us, and they are a conservative, resistant lot. We must not scare the pants off them, but we must make them acknowledge the fact that there is a serious problem.
	Climate change is an extremely important issue for the Government, and a great deal has been said about that. We have introduced a draft Climate Change Bill, which we are very keen on, and which we want to develop. The leader of the Opposition wears organic trainers, whatever that means, but despite all that, plant sciences have had a bad deal. Although stem cell research is the front-runner, plant sciences have as much to offer in tackling climate change as anything else, so I am very pleased to present this debate.

Barry Gardiner: It is always a pleasure to respond to a debate introduced by my hon. Friend the Member for Norwich, North (Dr. Gibson), because he has an unparalleled knowledge of science in the House, having chaired the Select Committee on Science and Technology. His scientific background, too, stands him in tremendously good stead. This evening, he spoke about many things including, first, the need to plant trees, as well as biofuels and the danger of monoculture. I hope that he agrees that peat bog remediation is every bit as important as the need to plant trees. I was on the top of Blackmoor in the Peak district at the weekend looking at the depletion in the peat. The peat bogs in this country represent a greater sequestion of carbon than the entire forests of France and the UK combined. They are infinitely more powerful, and they store carbon for thousands of years, rather than just for hundreds of years, as standing forests do.
	My hon. Friend spoke about the dangers of biofuels, particularly of monoculture. Bioethanol can be a very good biofuel if it is used instead of petrol, but it is not so good if, to produce it, we destroy virgin rainforest, and I absolutely agree with the point that he made. I wanted to pick up one more initial point in his contribution, and echo his praise both for the talented researchers in this country and for their work on plant science and in other scientific areas. That is certainly an industry that will come more and more to the fore as we face up to the problems of climate change.
	Agriculture as a whole contributes 7 per cent. of all UK greenhouse gas emissions and 14 per cent. globally. About 36 per cent. of the UK's total methane emissions and 67 per cent. of nitrous oxide emissions come from agriculture—for example, from artificial fertiliser, manure and livestock. Although agriculture is only directly responsible for around 1 per cent. of UK carbon dioxide emissions, the sector can help to mitigate CO2 emissions from other sources through carbon sequestration in soils, as we have mentioned, and timber, and by producing energy crops to replace fossil fuels.
	On 13 March this year we published the draft Climate Change Bill for consultation and pre-legislative scrutiny. The Bill would make the UK the first country to set a long-term legal framework for reducing emissions over the next 45 years and beyond. Although the draft Bill focuses on carbon dioxide, which is not the most significant greenhouse gas for agriculture, the independent committee on climate change, which the Bill establishes, will have a duty to advise the Government in relation to other greenhouse gases whenever the Government asks it to do so.
	Agriculture is central to helping us meet our objectives on climate change, and is significant in the UK's climate change programme. Farmers growing crops or rearing livestock on grassland will feel the impacts of our changing climate very directly, and they need to be ready to adapt to these impacts. All farmers have a major role to play—for example, by reducing their direct greenhouse gas emissions, managing the land in ways which help sequester carbon, and supplying bioenergy crops as an alternative to fossil fuels.
	DEFRA's agriculture and climate change research and development programme, which is worth around £5.6 million in this financial year, helps build understanding and evidence about the threats and opportunities that climate change presents, and about what farmers can do to reduce emissions. It includes research on climate change mitigation in agriculture, the impacts of climate change on farming, including both livestock and arable sectors, and the vulnerability of UK agriculture to extreme weather events, about which my hon. Friend spoke. This is within the 2007-08 DEFRA budget of £70 million for sustainable farming and food science, including animal health and welfare.
	Specifically in relation to plant science, our research and development programme is looking, for example, at the vulnerability of crops to extreme weather events, which are expected to increase with climate change; at the long-term plant breeding challenges faced by the plant breeding sector; at how to develop crops for energy that will support our climate change and renewable energy targets, at a price which is competitive in the market for renewable energy; at how to increase commercial yields of biomass crops; and at how to determine and demonstrate the most economical systems for growing biomass crops, consistent with the protection of the environment and, of course, with minimal use of pesticides and fertilisers.
	The direct effects of climate change on crops has been well researched in DEFRA research and development. Further research is being commissioned to build on this. Current considerations suggest that climate change impacts do not threaten the viability of UK agriculture as a whole, but particular regions and individual farm businesses need to be aware of both the risks and the opportunities. In decades to come the impacts of climate change will be more defined, with winter rain becoming more sporadic and intense, and summer rain more scarce.
	Crop yields are affected by many factors associated with climate change, including temperature, rainfall, carbon dioxide concentration in the atmosphere, extreme weather events and climate variability. Models developed through the research that the Biotechnology and Biological Science Research Council and DEFRA have funded on plant science and crop development are producing predictions based on possible climate scenarios. These can be updated as more reliable models of climate change become available.
	Potential threats from climate change to farmers growing crops include prolonged and more frequent droughts, changes in rainfall distribution, increased risk of new crop diseases or some pests becoming more serious, and increased vulnerability of crops to variable or extreme temperatures. Soils are also likely to be affected by variation in temperature and rainfall. Some soils are likely to form impenetrable caps, increasing the risk of run-off and subsequent pollution events and flooding. Cracking in soils after dry periods may prevent rainfall from being retained and further increase subsequent droughts. Hotter, drier summers may also affect subsoils and make it more difficult for plant roots to penetrate and grow.
	On the other hand, rising temperatures and longer growing seasons will provide opportunities for farmers to grow new crops, such as energy crops, and supply new markets. For some commodities, the UK could have an advantage compared with traditional competitors. As the climate changes, some crops will become easier to grow and others harder. Landscape features may also change—for example where crops grown for fuel replace those grown for food or set-aside.
	We have a continuing programme of research looking at the contribution of different land management practices to climate change objectives—both adaptation and mitigation. Through previous work, which has been published, the UK is well served with information on impacts.
	We need to work with farmers and land managers, and with organisations such as the Rural Climate Change Forum, to ensure that farmers have the information and advice they need to turn the results from climate change research into practical action to reduce greenhouse gas emissions, as well as to adapt to these impacts and make the most of new opportunities.
	Basic plant science in the UK is funded by BBSRC rather than DEFRA. The BBSRC investment includes a large proportion of the £30 million per annum spent at its research institutes—Rothamsted, the John Innes Institute in Norwich and the Institute of Grassland and Environmental Research, and there are also many projects funded at universities related to plant science. Much of that research investigates the fundamental processes in the life of plants that climate change is likely to affect. By understanding how these responses work and linking them to the genes involved in well- studied "model" plant species, scientists and subsequently commercial plant breeders will be able to breed characteristics into crops to help them tolerate and continue to grow under more extreme conditions.
	In addition to DEFRA's specific agriculture and climate change research, the UK spends about £5 million annually on research and development connected with the genetic improvement of UK-grown crops. This will underpin the development of crop varieties better suited to future climates and new crops and markets. The DEFRA research links with a specific BBSRC crop science initiative, which seeks to apply results from fundamental plant science to crops. These together form a basis for collaborative work with industry—with plant breeders and farming organisations.
	For major field crops, including wheat, oilseed rape, biomass, pulse crops and oats we have invested in resources and techniques to underpin plant breeding by creating crop genetic improvement networks that focus on traits that will help commercial breeders introduce varieties that can improve the environmental footprint of production systems or help to address the likely stresses on crop plants from climate change. Similar projects are in place for grass and forage and some horticultural crops.
	The oilseed rape genetic improvement network—OREGIN—provides an example of the collaborative work in progress. Researchers based at Rothamsted, the John Innes Institute, Warwick university and elsewhere are all involved. Since it was established in 2003 it has provided a focus for the research and stakeholder communities associated with oilseed rape and brassica crops. The project has provided reference and experimental material and built expertise as a basis for studying aspects that may be affected by changing temperature, such as oil profiles and risks from attack by pests and pathogens, and the more efficient use of inputs, such as nitrogen fertiliser.
	Scientists in our leading institutes are therefore working, often in collaboration with others, to understand and model how crops will perform in a range of future possible climate scenarios. They are also working in conjunction with others to develop crops that are currently well adapted to the UK or have potential here so that they remain productive as the climate changes.
	The threat of increased summer drought to crops and water availability for irrigated high-value crops in eastern England is of particular concern. Research commissioned by DEFRA is looking at the volume of water used by farmers and growers to irrigate crops and its impact on water resources. This will include work to develop more efficient ways of using water in the light of future climate change.
	Climate change and increasing global trade also bring additional risks from pests and diseases to which current crop varieties may be more susceptible. Improved genetic resistance to threats that could become more serious will prevent future damage and losses without the need for additional pesticide applications.
	As winters become warmer and wetter, conditions are likely to improve for certain crop pathogen species. Some pathogens such as species of Fusarium that cause ear blight in cereals are not yet major problems in the UK. These may become an increasing risk, especially if conditions also favour the production of grain maize, which is an alternative host. These fungi are associated with the production of mycotoxins in grain, which presents a health risk to humans and to animals.
	Besides concerns about predicted changes to some pests that may become more serious, there are also concerns that organisms of conservation found in farmed environments may in contrast become rarer, and the need to devise sustainable conservation strategies, for example, in conjunction with agri-environmental schemes, will be greater.

Ian Gibson: Considering all this activity that has gone on, does my hon. Friend think that the agricultural industry knows about it, or does it go on without its knowledge, or even interest?

Barry Gardiner: My hon. Friend characterised farmers who were "conservative"—I am sure that he used that word adjectivally with a small "c" rather than to denote any political association. In fact, I have been pleasantly surprised by farmers' willingness to see themselves increasingly as land managers, landscape managers and environmental managers who are prepared to get their remuneration not from the subsidies for production that we used to, and in some cases still do, pay as a result of the common agricultural policy, but as a result of the public goods that they are creating. They are increasingly ahead of those in many places in the rest of Europe in appreciating their role to that effect—
	 The motion having been made after Ten o'clock, and the debate having continued for half an hour, Mr. Speaker  adjourned the House without Question put, pursuant to the Standing Order.
	 Adjourned at four minutes to Eleven o'clock.